Provider Demographics
NPI:1487002291
Name:HADAR, TALI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TALI
Middle Name:
Last Name:HADAR
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:PSC 851 BOX 340
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834-0004
Mailing Address - Country:US
Mailing Address - Phone:318-439-8164
Mailing Address - Fax:
Practice Address - Street 1:95121 VILLAGGIO DEGLI ULIVI
Practice Address - Street 2:
Practice Address - City:SIGONELLA
Practice Address - State:CATANIA
Practice Address - Zip Code:95121
Practice Address - Country:IT
Practice Address - Phone:314-624-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98115731223X0400X, 390200000X, 1223G0001X
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN