Provider Demographics
NPI:1639143175
Name:TZIVAS, TOM (DDS)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:TZIVAS
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 1:921 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2821
Mailing Address - Country:US
Mailing Address - Phone:718-745-1205
Mailing Address - Fax:
Practice Address - Street 1:368 97TH ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7854
Practice Address - Country:US
Practice Address - Phone:718-238-1882
Practice Address - Fax:718-238-3631
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0411471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist