Healthcare Provider Details

I. General information

NPI: 1225767510
Provider Name (Legal Business Name): TIFFANI BLESSIE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST STE 190
PHOENIX AZ
85044-9140
US

IV. Provider business mailing address

2177 S MCQUEEN RD APT 3092
CHANDLER AZ
85286-1852
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-2474
  • Fax:
Mailing address:
  • Phone: 815-579-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD011420
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011420
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: