Provider Demographics
NPI:1295948636
Name:TEHRANI, TALI (DDS)
Entity type:Individual
Prefix:DR
First Name:TALI
Middle Name:
Last Name:TEHRANI
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 1:10636 WILSHIRE BLVD APT 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7326
Mailing Address - Country:US
Mailing Address - Phone:310-474-7010
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD STE 410
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2239
Practice Address - Country:US
Practice Address - Phone:818-784-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry