Provider Demographics
NPI:1184797714
Name:TASHJIAN, BARBARA E (DDS)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:E
Last Name:TASHJIAN
Suffix:
Gender:F
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:N8784 1060TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4705
Mailing Address - Country:US
Mailing Address - Phone:715-426-5362
Mailing Address - Fax:715-273-6854
Practice Address - Street 1:412 W. KINNE ST.
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-0238
Practice Address - Country:US
Practice Address - Phone:715-273-6755
Practice Address - Fax:715-273-6854
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4419-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33789100Medicaid