Provider Demographics
NPI:1437772415
Name:TARABISHY, DANA (DMD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:TARABISHY
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 1:25049 LAMBRUSCO LOOP
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-1807
Mailing Address - Country:US
Mailing Address - Phone:352-442-9633
Mailing Address - Fax:
Practice Address - Street 1:165 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8102
Practice Address - Country:US
Practice Address - Phone:813-643-6969
Practice Address - Fax:813-643-6556
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858802122300000X
390200000X
FLDN25574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program