| NPI | 1386801231 |
|---|---|
| Former Name | TIFFANY GRANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: OH 30.022774) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30.022774) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2018-06-06 |