Provider Demographics
NPI:1437772415
Name:TARABISHY, DANA (DMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:TARABISHY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 RIVERPATH DR APT 37
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4084
Mailing Address - Country:US
Mailing Address - Phone:352-442-9633
Mailing Address - Fax:
Practice Address - Street 1:3037 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3226
Practice Address - Country:US
Practice Address - Phone:772-212-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858802122300000X
390200000X
FLDN25574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program