| NPI | 1962132936 |
|---|---|
| Former Name | TIFFANY JANE VALENCIA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601354) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI Student) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2022-06-22 |