Healthcare Provider Details

I. General information

NPI: 1205198983
Provider Name (Legal Business Name): TAHER DHOON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 W 20TH ST
GREELEY CO
80634-3038
US

IV. Provider business mailing address

5214 W 20TH ST
GREELEY CO
80634-3038
US

V. Phone/Fax

Practice location:
  • Phone: 970-352-4242
  • Fax: 970-352-4246
Mailing address:
  • Phone: 970-352-4242
  • Fax: 970-352-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6421
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00202333
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: