Provider Demographics
NPI:1861583916
Name:TAHERI, MOHSEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:TAHERI
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 1:575 UNDERHILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3416
Mailing Address - Country:US
Mailing Address - Phone:516-496-3880
Mailing Address - Fax:516-496-4662
Practice Address - Street 1:575 UNDERHILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3416
Practice Address - Country:US
Practice Address - Phone:516-496-3880
Practice Address - Fax:516-496-4662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043600-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice