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General NPI Number Information
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NPI Number | 1619285970
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Entity Type | Organization
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Legal Business Name | TIFFIN DENTAL ASSOCIATES
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 27 ST LAWRENCE DR SUITE 109
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City | TIFFIN
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State | OH
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Zip | 44883-8312
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Country | US
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Telephone | 419-447-7337
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Fax | 419-447-7003
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Provider Business Mailing Address
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Address Line | 27 ST LAWRENCE DR SUITE 109
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City | TIFFIN
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State | OH
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Zip | 44883-8312
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Country | US
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Telephone | 419-447-7337
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Fax | 419-447-7003
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROL J MOORE
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Credential |
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Telephone | 419-447-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30022212
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30018784
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License Number State | OH
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