Provider Demographics
NPI:1457535502
Name:TAVABI, LALEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LALEH
Middle Name:
Last Name:TAVABI
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 1:324 WEST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3213
Mailing Address - Country:US
Mailing Address - Phone:516-432-2837
Mailing Address - Fax:516-432-6319
Practice Address - Street 1:324 WEST PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3213
Practice Address - Country:US
Practice Address - Phone:516-432-2837
Practice Address - Fax:516-432-6319
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist