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General NPI Number Information
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NPI Number | 1710367297
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Entity Type | Individual
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Provider Name | AMIR SHAHAB ASHTIANI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 938 WURZBACH PKWY STE 107
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City | SAN ANTONIO
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State | TX
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Zip | 78231
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Country | US
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Telephone | 210-610-7772
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Fax | 210-904-2345
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Provider Business Mailing Address
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Address Line | 938 WURZBACH PKWY STE 107
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City | SAN ANTONIO
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State | TX
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Zip | 78231-2438
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Country | US
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Telephone | 210-610-7772
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Fax | 210-904-2345
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30918
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License Number State | TX
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