Healthcare Provider Details

I. General information

NPI: 1306770557
Provider Name (Legal Business Name): TIFFANY SHAWNA KING DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7271 GOODMAN RD
OLIVE BRANCH MS
38654-1906
US

IV. Provider business mailing address

116 PRIVATE ROAD 3049
OXFORD MS
38655-5632
US

V. Phone/Fax

Practice location:
  • Phone: 901-861-0031
  • Fax: 901-861-4031
Mailing address:
  • Phone: 901-861-0031
  • Fax: 901-861-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112657
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: