Provider Demographics
NPI:1750827689
Name:MEISENBERG, TAMILLA (DDS)
Entity Type:Individual
Prefix:
First Name:TAMILLA
Middle Name:
Last Name:MEISENBERG
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 1:600 WARREN RD
Mailing Address - Street 2:APT 6-3C
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1854
Mailing Address - Country:US
Mailing Address - Phone:607-758-7700
Mailing Address - Fax:
Practice Address - Street 1:600 WARREN RD
Practice Address - Street 2:APT 6-3C
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1854
Practice Address - Country:US
Practice Address - Phone:607-758-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice