Provider Demographics
NPI:1083809404
Name:SHUTTLESWORTH, TIFANI POSKEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFANI
Middle Name:POSKEY
Last Name:SHUTTLESWORTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIFANI
Other - Middle Name:CARROLLE
Other - Last Name:POSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6300 STATE HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-8966
Mailing Address - Country:US
Mailing Address - Phone:903-675-0023
Mailing Address - Fax:
Practice Address - Street 1:6300 STATE HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-8966
Practice Address - Country:US
Practice Address - Phone:903-675-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist