MEDICARE: DR. FAHIMEH TAFRESHI DDS

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	122300000X	Dentist	046696	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558446591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAHIMEH TAFRESHI DDS

Provider Business Mailing Address
First Line	:	1231 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472
Country	:	US
Telephone Number	:	718-822-7645
Fax Number	:	718-822-2673

Provider Business Practice Location Address
First Line	:	1231 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472
Country	:	US
Telephone Number	:	718-822-7645
Fax Number	:	718-822-2673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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