Provider Demographics
NPI:1003845991
Name:TASSI, IRMA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:M
Last Name:TASSI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2109 BAYSHORE BLVD
Mailing Address - Street 2:#403
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3155
Mailing Address - Country:US
Mailing Address - Phone:813-254-0747
Mailing Address - Fax:727-319-1146
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:MAIL CODE 160 BAY PINES VAHCS
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1146
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN154281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN15428OtherFL STATE LICENSE #