Healthcare Provider Details

I. General information

NPI: 1801318225
Provider Name (Legal Business Name): TIFFANY SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 02/24/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13730 MILLERVILLE GREENS BLVD # 1
BATON ROUGE LA
70816-1696
US

IV. Provider business mailing address

546 NORTHSHORE DR
TUSCALOOSA AL
35406-2065
US

V. Phone/Fax

Practice location:
  • Phone: 225-800-3438
  • Fax:
Mailing address:
  • Phone: 205-242-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6942
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6942
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: