Individual
NISA GOSHTASBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
50505 SCHOENHERR RD STE 170, SHELBY TOWNSHIP, MI 48315-3141
(586) 803-8300
Mailing address
2440 PARMENTER BLVD APT 201, ROYAL OAK, MI 48073-1339
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901022665
MI
Other
Enumeration date
06/11/2018
Last updated
06/11/2018
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