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General NPI Number Information
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NPI Number | 1699121186
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Entity Type | Individual
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Provider Name | TIFFANY TOWNSEL DDS
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Gender | Female
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 567 W 14TH ST UNIT C
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-2323
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Country | US
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Telephone | 708-747-7817
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 MEADOW LAKE DR
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City | RICHTON PARK
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State | IL
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Zip | 60471-1190
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Country | US
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Telephone | 708-743-8183
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031401
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License Number State | IL
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