MEDICARE: DAVID TASHMAN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	033727	NY

General Provider Information

NPI Number	:	1336419332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID TASHMAN DDS PC

Provider Business Mailing Address
First Line	:	POB 1001
Second Line	:	DAVID TASHMAN DDS PC
City	:	SOUTH SALEM
State	:	NY
Zip	:	10590
Country	:	US
Telephone Number	:	718-519-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 HENRY HUDSON PKWY W
Second Line	:	A-11
City	:	BRONX
State	:	NY
Zip	:	10471-3800
Country	:	US
Telephone Number	:	718-519-0500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID TASHMAN
Credential	:	DDS
Telephone Number	:	718-519-0500

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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