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General NPI Number Information
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NPI Number | 1790090272
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Entity Type | Organization
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Legal Business Name | ARDESHIR TAHERI-TAFRESHI DMD, INC.
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 3200 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6723
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Country | US
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Telephone | 718-761-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6723
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Country | US
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Telephone | 718-761-3200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARDESHIR TAHERI-TAFRESHI
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Credential | DMD
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Telephone | 718-761-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 054824
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License Number State | NY
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