MEDICARE: TALI DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	046106	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063631851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALI DENTISTRY

Provider Business Mailing Address
First Line	:	1176 LIBERTY AVE # 2FL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3309
Country	:	US
Telephone Number	:	718-827-6001
Fax Number	:	718-277-3938

Provider Business Practice Location Address
First Line	:	1176 LIBERTY AVE # 2FL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3309
Country	:	US
Telephone Number	:	718-827-6001
Fax Number	:	718-277-3938

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. FEREYDOUN KHALILI
Credential	:	INDRA
Telephone Number	:	718-827-6001

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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Directions to “TALI DENTISTRY ” Practice Location

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