Provider Demographics
NPI:1609913748
Name:TESSEL, MARILYN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:TESSEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:PRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 PINEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1431
Mailing Address - Country:US
Mailing Address - Phone:845-633-8899
Mailing Address - Fax:
Practice Address - Street 1:11 WILBUR ROAD
Practice Address - Street 2:
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984
Practice Address - Country:US
Practice Address - Phone:845-947-6206
Practice Address - Fax:845-947-6209
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016630-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist