Provider Demographics
NPI:1336823277
Name:YANES TARANCON, BORIS (DMD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:YANES TARANCON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 HARRISON AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1909
Mailing Address - Country:US
Mailing Address - Phone:786-580-6991
Mailing Address - Fax:
Practice Address - Street 1:400 HARRISON AVE STE 201
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1720
Practice Address - Country:US
Practice Address - Phone:973-484-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28023122300000X
NJ22DI02972900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist