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General NPI Number Information
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NPI Number | 1699336412
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Entity Type | Individual
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Provider Name | TIFFANY HUDSON DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 5363 BALBOA BLVD STE 330
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City | ENCINO
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State | CA
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Zip | 91316-2831
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Country | US
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Telephone | 818-981-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 30212 VIA VICTORIA
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-4440
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Country | US
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Telephone | 310-938-6526
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DDS100923
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License Number State | CA
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