MEDICARE: DR. ALINA TIRASPOLSKAYA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	57682	CA
2	1223G0001X	General Practice Dentistry	57682	CA

General Provider Information

NPI Number	:	1467788620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALINA TIRASPOLSKAYA D.D.S.

Provider Business Mailing Address
First Line	:	440 N HAYWORTH AVE APT 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2732
Country	:	US
Telephone Number	:	323-497-1303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 SELBY AVE APT 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5865
Country	:	US
Telephone Number	:	323-497-1303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	08/13/2014

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