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General NPI Number Information
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NPI Number | 1104264266
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Entity Type | Individual
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Provider Name | TIFFANY MARIE TEEGARDEN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1215 N 7 HWY
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2281
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Country | US
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Telephone | 816-427-1164
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Fax |
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Provider Business Mailing Address
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Address Line | 548 SE COLONIAL DR
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-5499
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Country | US
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Telephone | 620-770-2620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2013016361
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License Number State | MO
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