MEDICARE: DR. CHRISTOPHER DAVID TIFFIN D.D.S

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	19366	MI

General Provider Information

NPI Number	:	1952424434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DAVID TIFFIN D.D.S

Provider Business Mailing Address
First Line	:	375 W HUDSON AVE
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3945
Country	:	US
Telephone Number	:	248-930-1825
Fax Number	:	734-421-7935

Provider Business Practice Location Address
First Line	:	8010 N MIDDLEBELT RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1808
Country	:	US
Telephone Number	:	734-421-2675
Fax Number	:	734-421-7935

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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