MEDICARE: DR. TIFFANI BROOKE DUNN D.M.D.

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	122300000X	Dentist	DT2379	HI
2	122300000X	Dentist	26440	TX

General Provider Information

NPI Number	:	1437388501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANI BROOKE DUNN D.M.D.

Provider Business Mailing Address
First Line	:	1218 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1535
Country	:	US
Telephone Number	:	210-928-2814
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6768
Country	:	US
Telephone Number	:	281-337-0313
Fax Number	:

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	07/11/2011

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