Provider Demographics
NPI:1467788620
Name:TIRASPOLSKAYA, ALINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:
Last Name:TIRASPOLSKAYA
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 1:440 N HAYWORTH AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2732
Mailing Address - Country:US
Mailing Address - Phone:323-497-1303
Mailing Address - Fax:
Practice Address - Street 1:1914 SELBY AVE APT 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5865
Practice Address - Country:US
Practice Address - Phone:323-497-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57682122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist