NPI | 1972735611 |
---|---|
Former Name | TIFFANY IRIS ALLEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN 21023) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 054549) |
Enumeration Date | 2009-08-13 |
Last Update Date | 2014-12-09 |