Provider Demographics
NPI:1427274281
Name:TARASEVICH, NATALIA (DDS)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:TARASEVICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:TSAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8074 HOBBES WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6071
Mailing Address - Country:US
Mailing Address - Phone:239-595-7474
Mailing Address - Fax:
Practice Address - Street 1:11380 PROSPERITY FARMS RD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3450
Practice Address - Country:US
Practice Address - Phone:561-833-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164551223G0001X
NY050599122300000X
NJ22DI022319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist