MEDICARE: DR. TIFFANY WINBURN 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	1223G0001X	General Practice Dentistry	5542	NV

General Provider Information

NPI Number	:	1669670162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY WINBURN D.M.D.

Provider Business Mailing Address
First Line	:	2268 LYRICAL RD
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6529
Country	:	US
Telephone Number	:	702-492-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 E FLAMINGO RD
Second Line	:	SUITE 17-A
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5276
Country	:	US
Telephone Number	:	702-892-0910
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	11/26/2007

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