Provider Demographics
NPI:1164686812
Name:KENT, TIFFANY LAUREN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LAUREN
Last Name:KENT
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Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:4070 LAKE DR SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8294
Mailing Address - Country:US
Mailing Address - Phone:616-888-2948
Mailing Address - Fax:616-888-2949
Practice Address - Street 1:4070 LAKE DR SE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8294
Practice Address - Country:US
Practice Address - Phone:616-888-2948
Practice Address - Fax:616-888-2949
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012011148207W00000X, 207WX0200X
IL036134962207WX0200X
MI4301092933207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology