Healthcare Provider Details

I. General information

NPI: 1326534595
Provider Name (Legal Business Name): MS. TIFFANY COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 RICHMOND HWY
ALEXANDRIA VA
22306-6647
US

IV. Provider business mailing address

3921 PENSHURST LN APT 203
WOODBRIDGE VA
22192-6350
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-5568
  • Fax:
Mailing address:
  • Phone: 917-776-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402206498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: