Provider Demographics
NPI:1790137552
Name:TIM TIRALOSI D.M.D. LLC
Entity Type:Organization
Organization Name:TIM TIRALOSI D.M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRALOSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-333-1335
Mailing Address - Street 1:731 STIRLING CENTER PL
Mailing Address - Street 2:SUITE 1951
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5209
Mailing Address - Country:US
Mailing Address - Phone:407-333-1335
Mailing Address - Fax:407-333-1244
Practice Address - Street 1:731 STIRLING CENTER PL
Practice Address - Street 2:SUITE 1951
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5209
Practice Address - Country:US
Practice Address - Phone:407-333-1335
Practice Address - Fax:407-333-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty