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General NPI Number Information
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NPI Number | 1548820764
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Entity Type | Individual
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Provider Name | TARA FIROUZI DDS
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 30801 SCHOENHERR RD
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City | WARREN
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State | MI
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Zip | 48088-6857
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Country | US
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Telephone | 313-494-6907
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 FERN ST
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City | ROYAL OAK
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State | MI
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Zip | 48073-4185
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Country | US
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Telephone | 212-321-0340
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19234150800
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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