Individual
GRAYSON ELLIOT TISHKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1500 E. MEDICAL CENTER DRIVE, G1100 TOWSLEY CENTER, ANN ARBOR, MI 48109-5222
(734) 232-6048
Mailing address
1500 E. MEDICAL CENTER DRIVE, G1100 TOWSLEY CENTER, ANN ARBOR, MI 48109-5222
(734) 232-6048
(734) 936-5941
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2901601415
MI
Other
Enumeration date
06/10/2022
Last updated
06/17/2024
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