Provider Demographics
NPI:1659564813
Name:TOSYALI, MUHLISE DIDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MUHLISE
Middle Name:DIDE
Last Name:TOSYALI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2113
Mailing Address - Country:US
Mailing Address - Phone:845-856-5049
Mailing Address - Fax:845-856-3000
Practice Address - Street 1:155 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2113
Practice Address - Country:US
Practice Address - Phone:845-856-5049
Practice Address - Fax:845-856-3000
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist