Healthcare Provider Details

I. General information

NPI: 1023650306
Provider Name (Legal Business Name): NARGES ATABAKHSH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7663
  • Fax: 954-262-1782
Mailing address:
  • Phone: 954-262-7663
  • Fax: 954-262-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: