Provider Demographics
NPI:1689201048
Name:TIRSUN, DEBORAH JILLIAN (DDS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JILLIAN
Last Name:TIRSUN
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 1:1 GUSTAVE L LEVY PL # 1187
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-423-4500
Mailing Address - Fax:646-476-4704
Practice Address - Street 1:1 GUSTAVE L LEVY PL # 1187
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-423-4500
Practice Address - Fax:646-476-4704
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY062062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program