Healthcare Provider Details

I. General information

NPI: 1568027845
Provider Name (Legal Business Name): TIFFANY A LEGORE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

IV. Provider business mailing address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-278-7568
Mailing address:
  • Phone: 541-966-9830
  • Fax: 541-278-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: