Individual
CARMINE L TISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9530 MAIN ST, CLARENCE, NY 14031
(716) 759-2255
(716) 759-1318
Mailing address
9530 MAIN ST, CLARENCE, NY 14031
(716) 759-2255
(716) 759-1318
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
036870
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00072046001
BLUE CROSS SHIELD
NY
01
—
4000196
INDEPENDENT HEALTH
NY
Enumeration date
03/05/2007
Last updated
07/08/2007
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