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General NPI Number Information
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NPI Number | 1750149381
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Entity Type | Individual
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Provider Name | PEYMAN BASTANI DMD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 1707 W CHARLESTON BLVD STE 290
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City | LAS VEGAS
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State | NV
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Zip | 89102-2353
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Country | US
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Telephone | 702-774-5134
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CHILPANCINGO PKWY APT 3205
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City | PLEASANT HILL
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State | CA
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Zip | 94523-1376
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Country | US
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Telephone | 925-852-4641
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8042
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License Number State | NV
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