Provider Demographics
NPI:1629197710
Name:TSOTSIASHVILI, MIKHAIL L (DDS)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:L
Last Name:TSOTSIASHVILI
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 1:1657 CLEMENT ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2361
Mailing Address - Country:US
Mailing Address - Phone:415-776-8581
Mailing Address - Fax:415-441-6224
Practice Address - Street 1:2675 GEARY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3443
Practice Address - Country:US
Practice Address - Phone:415-776-8581
Practice Address - Fax:415-441-6224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice