Provider Demographics
NPI:1699975060
Name:GOSHTASBI, RAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:GOSHTASBI
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 1:9999 MIRA MESA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1006
Mailing Address - Country:US
Mailing Address - Phone:858-271-1010
Mailing Address - Fax:
Practice Address - Street 1:9999 MIRA MESA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1006
Practice Address - Country:US
Practice Address - Phone:858-271-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice