Provider Demographics
NPI:1932252095
Name:TABATABAIE, TARANEH (DMD)
Entity type:Individual
Prefix:DR
First Name:TARANEH
Middle Name:
Last Name:TABATABAIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4105
Mailing Address - Country:US
Mailing Address - Phone:401-722-5800
Mailing Address - Fax:401-722-6718
Practice Address - Street 1:1234 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4105
Practice Address - Country:US
Practice Address - Phone:401-722-5800
Practice Address - Fax:401-722-6718
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN025281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITT24690Medicaid