| NPI | 1679720247 |
|---|---|
| Former Name | TIFFANY MELISSA STAFIEJ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN18099) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019615) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2014-12-08 |