=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851822928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLURE SMILE DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2017
-----------------------------------------------------
Last Update Date | 03/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 HELEN LN
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11024-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-405-9437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 HELEN LN
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11024-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-405-9437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. FARINAZ TAZEH
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 917-405-9437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 055238
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------