Provider Demographics
NPI:1588938286
Name:SHABESTARI, BABAK (DDS)
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:SHABESTARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 STANDIFORD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-574-9600
Mailing Address - Fax:209-574-9630
Practice Address - Street 1:2000 STANDIFORD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-574-9600
Practice Address - Fax:209-574-9630
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice