Provider Demographics
NPI:1043256621
Name:CASPIAN DENTAL, LLC
Entity type:Organization
Organization Name:CASPIAN DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIBANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-221-7171
Mailing Address - Street 1:83 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4181
Mailing Address - Country:US
Mailing Address - Phone:781-221-7171
Mailing Address - Fax:781-221-0171
Practice Address - Street 1:83 CAMBRIDGE ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4181
Practice Address - Country:US
Practice Address - Phone:781-221-7171
Practice Address - Fax:781-221-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196011223G0001X
MA194601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty