| NPI | 1720334469 |
|---|---|
| Former Name | TIFFANY LEE PAYNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 163709) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415690) |
| 124Q00000X Dental Hygienist (Licence: TX 11759) | |
| 124Q00000X Dental Hygienist (Licence: NM DH3737) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2020-08-31 |