Provider Demographics
NPI:1306393921
Name:TIRADO, CARMEN JULIA (RDH)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JULIA
Last Name:TIRADO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172-15 93RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1210
Mailing Address - Country:US
Mailing Address - Phone:718-715-9979
Mailing Address - Fax:
Practice Address - Street 1:172-15 93RD AVENUE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1210
Practice Address - Country:US
Practice Address - Phone:718-715-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025694124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist