Healthcare Provider Details

I. General information

NPI: 1902395890
Provider Name (Legal Business Name): NEGAR NORA TABARI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEGAR ZEIAE BAKHSH TABARI

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 SUMMIT AVE
HACKENSACK NJ
07601-1310
US

IV. Provider business mailing address

248 N FULLERTON AVE # NJ07042
MONTCLAIR NJ
07042-3909
US

V. Phone/Fax

Practice location:
  • Phone: 201-525-0202
  • Fax:
Mailing address:
  • Phone: 423-737-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02743802
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: