Provider Demographics
NPI:1023101300
Name:TACVORIAN, TACUHI SONA (DMD)
Entity type:Individual
Prefix:DR
First Name:TACUHI
Middle Name:SONA
Last Name:TACVORIAN
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 1:24 CRESCENT ST
Mailing Address - Street 2:# 302
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4358
Mailing Address - Country:US
Mailing Address - Phone:781-899-8174
Mailing Address - Fax:
Practice Address - Street 1:24 CRESCENT ST
Practice Address - Street 2:# 302
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4358
Practice Address - Country:US
Practice Address - Phone:781-899-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice