Provider Demographics
NPI:1124450523
Name:TAQAVI, POUYAN (DDS)
Entity type:Individual
Prefix:
First Name:POUYAN
Middle Name:
Last Name:TAQAVI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5079
Mailing Address - Country:US
Mailing Address - Phone:661-587-3512
Mailing Address - Fax:
Practice Address - Street 1:3401 COFFEE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5079
Practice Address - Country:US
Practice Address - Phone:661-587-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist