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General NPI Number Information
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NPI Number | 1831748417
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Entity Type | Individual
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Provider Name | TIFFANY TAVARES DDS, DMSC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2019
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 8210 FLOYD CURL DR # 8109
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3923
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Country | US
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Telephone | 210-450-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 7703 FLOYD CURL DR # 7914
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3901
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Country | US
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Telephone | 210-450-3088
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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 | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | 2019034508
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | 36888
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 36888
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License Number State | TX
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