Provider Demographics
NPI:1790090272
Name:ARDESHIR TAHERI-TAFRESHI DMD, INC.
Entity Type:Organization
Organization Name:ARDESHIR TAHERI-TAFRESHI DMD, INC.
Other - Org Name:
Other - Org Type:
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:2010-08-09
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054824261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental