Provider Demographics
NPI:1689449001
Name:TYTYK, IRYNA (DMD)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:TYTYK
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 1:1650 SW 7TH CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-7036
Mailing Address - Country:US
Mailing Address - Phone:954-612-8688
Mailing Address - Fax:
Practice Address - Street 1:3601 E WEST HWY STE A2
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2060
Practice Address - Country:US
Practice Address - Phone:301-277-1462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist