Provider Demographics
NPI:1376386037
Name:TAHSEEN, TUBA (DMD)
Entity type:Individual
Prefix:
First Name:TUBA
Middle Name:
Last Name:TAHSEEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11223 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3711
Mailing Address - Country:US
Mailing Address - Phone:814-547-5617
Mailing Address - Fax:
Practice Address - Street 1:11223 SHAW AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3711
Practice Address - Country:US
Practice Address - Phone:814-547-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist