Provider Demographics
NPI:1104381615
Name:BENTLER, TIFFANY ROSE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROSE
Last Name:BENTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 EASTWOOD CIR SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4372
Mailing Address - Country:US
Mailing Address - Phone:330-324-8550
Mailing Address - Fax:
Practice Address - Street 1:1264 EASTWOOD CIR SE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4372
Practice Address - Country:US
Practice Address - Phone:330-324-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program