MEDICARE: DR. DAVID TABAROKI D.D.S

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	047690	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	:	1487727319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID TABAROKI D.D.S

Provider Business Mailing Address
First Line	:	102 10 QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4722
Country	:	US
Telephone Number	:	718-544-4440
Fax Number	:	718-233-2723

Provider Business Practice Location Address
First Line	:	102 10 QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4722
Country	:	US
Telephone Number	:	718-544-4440
Fax Number	:	718-233-2723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/16/2010

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Directions to “ DR. DAVID TABAROKI D.D.S” Practice Location

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