Provider Demographics
NPI:1558446591
Name:TAFRESHI, FAHIMEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAHIMEH
Middle Name:
Last Name:TAFRESHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472
Mailing Address - Country:US
Mailing Address - Phone:718-822-7645
Mailing Address - Fax:718-822-2673
Practice Address - Street 1:1231 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472
Practice Address - Country:US
Practice Address - Phone:718-822-7645
Practice Address - Fax:718-822-2673
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01678775Medicaid