Provider Demographics
NPI:1962695783
Name:TAHERI-TAFRESHI, ARDESHIR (DMD)
Entity type:Individual
Prefix:DR
First Name:ARDESHIR
Middle Name:
Last Name:TAHERI-TAFRESHI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6723
Mailing Address - Country:US
Mailing Address - Phone:718-761-3200
Mailing Address - Fax:
Practice Address - Street 1:3200 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6723
Practice Address - Country:US
Practice Address - Phone:718-761-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508281223G0001X
NY0548241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice