Provider Demographics
NPI:1457541161
Name:TSISH, OKSANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OKSANA
Middle Name:
Last Name:TSISH
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 1:29 DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4442
Mailing Address - Country:US
Mailing Address - Phone:631-335-8945
Mailing Address - Fax:
Practice Address - Street 1:976 BARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3322
Practice Address - Country:US
Practice Address - Phone:718-448-9078
Practice Address - Fax:718-448-9492
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052447-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice