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Individual

DR. SHAHNAAZ NISTAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
48 AUBURN ST, AUBURN, MA 01501-2438
(508) 832-6278
Mailing address
45 OWENCROFT RD # 1, BOSTON, MA 02124-4723
(917) 892-3625

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
24242
TX
1223P0221X
Pediatric Dentistry
Primary
DN1857456
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1952610008
MA
Enumeration date
10/06/2010
Last updated
09/28/2019
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