Healthcare Provider Details

I. General information

NPI: 1891618658
Provider Name (Legal Business Name): LADAN TAHERI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 W CHESTER PIKE
UPPER DARBY PA
19082-1107
US

IV. Provider business mailing address

1300 FAIRMOUNT AVE UNIT 1212
PHILADELPHIA PA
19123-2486
US

V. Phone/Fax

Practice location:
  • Phone: 610-352-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045930
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: