Healthcare Provider Details

I. General information

NPI: 1932624830
Provider Name (Legal Business Name): TIFFANY MANZO JENKINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12495 W 32ND AVE
WHEAT RIDGE CO
80033-5256
US

IV. Provider business mailing address

12495 W 32ND AVE
WHEAT RIDGE CO
80033-5256
US

V. Phone/Fax

Practice location:
  • Phone: 303-237-2707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY N MANZO
Title or Position: OWNER DENTIST
Credential:
Phone: 303-237-2707