Provider Demographics
NPI:1063580702
Name:DASTMALCHI, YAS (DDS)
Entity type:Individual
Prefix:DR
First Name:YAS
Middle Name:
Last Name:DASTMALCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YASS
Other - Middle Name:
Other - Last Name:DASTMALCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3505 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4505
Mailing Address - Country:US
Mailing Address - Phone:925-299-0193
Mailing Address - Fax:925-299-0793
Practice Address - Street 1:3505 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4505
Practice Address - Country:US
Practice Address - Phone:925-299-0193
Practice Address - Fax:925-299-0793
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA424621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68039632OtherEIN