Provider Demographics
NPI:1063037596
Name:TURNER, TIFFANY CHU (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:CHU
Last Name:TURNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 WALDORF MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4874
Mailing Address - Country:US
Mailing Address - Phone:301-645-1344
Mailing Address - Fax:
Practice Address - Street 1:2992 WALDORF MARKET PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4874
Practice Address - Country:US
Practice Address - Phone:301-645-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17399122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17399OtherMARYLAND DENTAL LICENSE