MEDICARE: DR. TIFFANY N. JAMISON DDS

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	P58992	NY
2	122300000X	Dentist	58097	CA

General Provider Information

NPI Number	:	1063688349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY N. JAMISON DDS

Provider Business Mailing Address
First Line	:	6230 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3801
Country	:	US
Telephone Number	:	310-412-9291
Fax Number	:

Provider Business Practice Location Address
First Line	:	6230 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3801
Country	:	US
Telephone Number	:	310-412-9291
Fax Number	:

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	03/11/2009

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