Provider Demographics
NPI:1225387582
Name:CASCADA DENTAL PC
Entity Type:Organization
Organization Name:CASCADA DENTAL PC
Other - Org Name:CASCADA DENTAL PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:YARAGHI-JOSEPHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MPH
Authorized Official - Phone:646-244-9365
Mailing Address - Street 1:719 W 181ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4731
Mailing Address - Country:US
Mailing Address - Phone:646-244-9365
Mailing Address - Fax:
Practice Address - Street 1:719 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4731
Practice Address - Country:US
Practice Address - Phone:646-244-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052284-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty