Provider Demographics
NPI:1932363512
Name:TARYN SMITH JIROUSEK, DMD, PC
Entity type:Organization
Organization Name:TARYN SMITH JIROUSEK, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:JIROUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-299-3526
Mailing Address - Street 1:19 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1354
Mailing Address - Country:US
Mailing Address - Phone:315-673-1013
Mailing Address - Fax:315-673-2556
Practice Address - Street 1:19 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1354
Practice Address - Country:US
Practice Address - Phone:315-673-1013
Practice Address - Fax:315-673-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053079261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental