Provider Demographics
NPI:1780452706
Name:ARTDENTISTREE
Entity type:Organization
Organization Name:ARTDENTISTREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARANNUM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-827-5250
Mailing Address - Street 1:9 ARCADIA CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6319 FAIRVIEW AVE STE 103
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2889
Practice Address - Country:US
Practice Address - Phone:415-827-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental