Provider Demographics
NPI:1225280175
Name:TYSKA, EDWIN LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LOUIS
Last Name:TYSKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 DELAWARE RD.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223
Mailing Address - Country:US
Mailing Address - Phone:716-875-0405
Mailing Address - Fax:716-875-9620
Practice Address - Street 1:1077 DELAWARE RD.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223
Practice Address - Country:US
Practice Address - Phone:716-875-0405
Practice Address - Fax:716-875-9620
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist