Healthcare Provider Details

I. General information

NPI: 1184797714
Provider Name (Legal Business Name): BARBARA E TASHJIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W. KINNE ST.
ELLSWORTH WI
54011-0238
US

IV. Provider business mailing address

N8784 1060TH ST
RIVER FALLS WI
54022-4705
US

V. Phone/Fax

Practice location:
  • Phone: 715-273-6755
  • Fax: 715-273-6854
Mailing address:
  • Phone: 715-426-5362
  • Fax: 715-273-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4419-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: