Provider Demographics
NPI:1386633444
Name:ERFANIAN-TAHERI, KAMBIZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:
Last Name:ERFANIAN-TAHERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BARSTOW RD
Mailing Address - Street 2:STE 301
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2209
Mailing Address - Country:US
Mailing Address - Phone:516-466-4663
Mailing Address - Fax:
Practice Address - Street 1:7009 AUSTIN ST
Practice Address - Street 2:SUITE# 201
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4700
Practice Address - Country:US
Practice Address - Phone:718-793-5347
Practice Address - Fax:718-793-5352
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418868Medicaid