Provider Demographics
NPI:1073040028
Name:SCHROEDER, TIFFANY JENE (RDH)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JENE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JENE
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:7771 S ESTES ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-5217
Mailing Address - Country:US
Mailing Address - Phone:970-222-5463
Mailing Address - Fax:
Practice Address - Street 1:255 UNION BLVD STE 410
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1852
Practice Address - Country:US
Practice Address - Phone:303-284-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-20
Last Update Date:2017-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000904082124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist