Individual
DIBA DASTJERDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
68 NEW EDGERLY ROAD, BOSTON, MA 02115
(617) 262-5880
(617) 859-8804
Mailing address
68 NEW EDGERLY ROAD, BOSTON, MA 02115
(617) 262-5880
(617) 859-8804
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21835
MA
Other
Enumeration date
06/19/2007
Last updated
04/26/2013
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