Healthcare Provider Details

I. General information

NPI: 1053230193
Provider Name (Legal Business Name): TIFFANI KNIGHT-LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BALFOUR DR
ARCHDALE NC
27263-3117
US

IV. Provider business mailing address

4003 MACBETH ST
GREENSBORO NC
27410-3066
US

V. Phone/Fax

Practice location:
  • Phone: 336-431-7373
  • Fax:
Mailing address:
  • Phone: 202-290-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14643
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: