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NPI Code Detail

MEDICARE: TIFFANIE JILL ALBERTSON RDH

MEDICARE: TIFFANIE JILL ALBERTSON RDH
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
1124Q00000XDental Hygienist002876MO

General Provider Information

NPI Number : 1760516876
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANIE JILL ALBERTSON RDH
Provider Business Mailing Address
First Line : RR 1 BOX 146
Second Line :
City : LANCASTER
State : MO
Zip : 63548-9758
Country : US
Telephone Number : 660-457-3619
Fax Number :
Provider Business Practice Location Address
First Line : 1916 N BALTIMORE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-1902
Country : US
Telephone Number : 660-665-1901
Fax Number : 660-665-1903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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