Provider Demographics
NPI:1407157191
Name:ARDESHIR TAHERI-TAFRESHI DMD PC
Entity Type:Organization
Organization Name:ARDESHIR TAHERI-TAFRESHI DMD PC
Other - Org Name:DR. TAHERI SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDESHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERI-TAFRESHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-761-3200
Mailing Address - Street 1:3200 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6723
Mailing Address - Country:US
Mailing Address - Phone:718-761-3200
Mailing Address - Fax:
Practice Address - Street 1:3200 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6723
Practice Address - Country:US
Practice Address - Phone:718-761-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0548241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty