Healthcare Provider Details

I. General information

NPI: 1912914219
Provider Name (Legal Business Name): TIFFINIE A. ALLEN-EVANS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFINIE A. ALLEN DMD

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 GUNNIES DR
KODAK TN
37764-1107
US

IV. Provider business mailing address

9618 GUNNIES DR
KODAK TN
37764-1107
US

V. Phone/Fax

Practice location:
  • Phone: 865-978-7646
  • Fax:
Mailing address:
  • Phone: 865-978-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17621
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8848
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: