MEDICARE: DR. TALIA BISHLAWI JUST DMD

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	122300000X	Dentist	019.034465	IL
2	1223X2210X	Orofacial Pain Dentistry	DN10000934	MA
3	122300000X	Dentist	R856	MN

General Provider Information

NPI Number	:	1821782079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALIA BISHLAWI JUST DMD

Provider Business Mailing Address
First Line	:	872 MASSACHUSETTS AVE STE 2-4
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	508-408-9152
Fax Number	:

Provider Business Practice Location Address
First Line	:	872 MASSACHUSETTS AVE STE 2-4
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	508-408-9152
Fax Number	:

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

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	12/18/2025

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