MEDICARE: DR. JOHN PATRICK TISMO DMD

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	1223G0001X	General Practice Dentistry	DN18115	MA

General Provider Information

NPI Number	:	1891419446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK TISMO DMD

Provider Business Mailing Address
First Line	:	11975 TIMBERLAKE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1316
Country	:	US
Telephone Number	:	513-368-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	11975 TIMBERLAKE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1316
Country	:	US
Telephone Number	:	513-368-0707
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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