Healthcare Provider Details

I. General information

NPI: 1518245331
Provider Name (Legal Business Name): TYFFANI TYNNEIL PALMER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7451 N BEACH ST STE 140
FORT WORTH TX
76137-5160
US

IV. Provider business mailing address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

V. Phone/Fax

Practice location:
  • Phone: 817-847-7001
  • Fax: 817-847-7009
Mailing address:
  • Phone: 956-795-8100
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27199
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number27199
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: