Healthcare Provider Details

I. General information

NPI: 1821782079
Provider Name (Legal Business Name): TALIA BISHLAWI JUST DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 MASSACHUSETTS AVE STE 2-4
CAMBRIDGE MA
02139-3072
US

IV. Provider business mailing address

872 MASSACHUSETTS AVE STE 2-4
CAMBRIDGE MA
02139-3072
US

V. Phone/Fax

Practice location:
  • Phone: 508-408-9152
  • Fax:
Mailing address:
  • Phone: 508-408-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.034465
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDN10000934
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberR856
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: