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General NPI Number Information
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NPI Number | 1336823277
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Entity Type | Individual
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Provider Name | BORIS YANES TARANCON D.M.D
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 400 HARRISON AVE STE 201
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City | HARRISON
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State | NJ
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Zip | 07029-1720
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Country | US
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Telephone | 973-484-0979
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Fax |
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Provider Business Mailing Address
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Address Line | 730 HARRISON AVE APT 3G
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City | HARRISON
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State | NJ
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Zip | 07029-1909
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Country | US
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Telephone | 786-580-6991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28023
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02972900
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License Number State | NJ
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