Gary S Tisch, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-01-6250 Issued in OH

Practice address

20475 Farnsleigh Road
Suite 210
Shaker HTS., OH 44122

Phone

(216) 751-5555

Fax

(216) 757-5556

NPI assigned

Oct 31, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320019200000",
    "number": "1316223670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20475 FARNSLEIGH ROAD",
            "address_2": "SUITE 210",
            "city": "SHAKER HTS.",
            "state": "OH",
            "postal_code": "44122",
            "telephone_number": "216-751-5555",
            "fax_number": "216-757-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20475 FARNSLEIGH ROAD",
            "address_2": "SUITE 210",
            "city": "SHAKER HTS.",
            "state": "OH",
            "postal_code": "44122",
            "telephone_number": "216-751-5555",
            "fax_number": "216-757-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISCH",
        "first_name": "GARY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-01-6250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmin Thomas, LSW
• Robin-Maria Thomas
• Ronnie Thomas
• Kristyn Thompson
• Emanuel Love Thornton
• Tanya Denise Tolliver, LPN
• Lavado Townsend
• Anita Elizabeth Tripp Krajnik, N.D.
• Karen Tritt, RN
• Gabriela Trybus

• General Practice Dentistry in Shaker HTS., OH
• Providers in Shaker HTS., OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.