Healthcare Provider Details

I. General information

NPI: 1285648071
Provider Name (Legal Business Name): TIFFINEY TYLAINE HARPER D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRACE ST STE 200
ROCKY MOUNT NC
27804-5346
US

IV. Provider business mailing address

PO BOX 2723
ROCKY MOUNT NC
27802-2723
US

V. Phone/Fax

Practice location:
  • Phone: 252-210-9873
  • Fax: 252-316-8050
Mailing address:
  • Phone: 252-212-3486
  • Fax: 252-212-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7093
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: