MEDICARE: DR. TIFFANY LYNN SMITH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3944	WV

General Provider Information

NPI Number	:	1407204126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY LYNN SMITH DDS

Provider Business Mailing Address
First Line	:	1189 PINEVIEW DR
Second Line	:	SUITE A
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-0479
Country	:	US
Telephone Number	:	304-598-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1189 PINEVIEW DR
Second Line	:	SUITE A
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-0479
Country	:	US
Telephone Number	:	304-598-2030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	06/03/2016

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