Provider Demographics
NPI:1669461737
Name:TARANOV, STEVE (DDS)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:TARANOV
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 1:11 BROADWAY
Mailing Address - Street 2:MEZZANINE LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1303
Mailing Address - Country:US
Mailing Address - Phone:212-425-0505
Mailing Address - Fax:212-425-2120
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:MEZZANINE LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1303
Practice Address - Country:US
Practice Address - Phone:212-425-0505
Practice Address - Fax:212-425-2120
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049110-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice