Provider Demographics
NPI:1134318413
Name:TESSIER, MARYSE I
Entity Type:Individual
Prefix:DR
First Name:MARYSE
Middle Name:I
Last Name:TESSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARYSE
Other - Middle Name:I
Other - Last Name:TESSIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2801 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2401
Mailing Address - Country:US
Mailing Address - Phone:718-421-0224
Mailing Address - Fax:718-859-1119
Practice Address - Street 1:2801 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2401
Practice Address - Country:US
Practice Address - Phone:718-421-0224
Practice Address - Fax:718-859-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice