Healthcare Provider Details

I. General information

NPI: 1720415409
Provider Name (Legal Business Name): TIFFANY BIANCA HARRIS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD STE 134
REDLANDS CA
92373-4723
US

IV. Provider business mailing address

700 E REDLANDS BLVD STE U-123
REDLANDS CA
92373-6109
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63325
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: