Provider Demographics
NPI:1104117720
Name:EMPIRE DENTAL SERVICES, PC
Entity type:Organization
Organization Name:EMPIRE DENTAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFRESHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-822-7645
Mailing Address - Street 1:1231 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4903
Mailing Address - Country:US
Mailing Address - Phone:718-822-7645
Mailing Address - Fax:
Practice Address - Street 1:1231 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4903
Practice Address - Country:US
Practice Address - Phone:718-822-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046696261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental