Provider Demographics
NPI:1285854257
Name:TSESIS, IRINA (DDS)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:TSESIS
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 1:120 BRANDON TERR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6003
Mailing Address - Country:US
Mailing Address - Phone:518-862-0034
Mailing Address - Fax:
Practice Address - Street 1:740 HOOSICK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6679
Practice Address - Country:US
Practice Address - Phone:518-272-7716
Practice Address - Fax:518-727-7696
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405347Medicaid