Provider Demographics
NPI:1245419746
Name:TULIAO, NORA BORJA (DMD)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:BORJA
Last Name:TULIAO
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 1:215 WEST 94TH STREET
Mailing Address - Street 2:1012
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-772-2190
Mailing Address - Fax:
Practice Address - Street 1:215 W 94TH ST
Practice Address - Street 2:1012
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6922
Practice Address - Country:US
Practice Address - Phone:212-772-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist