Provider Demographics
NPI:1164743480
Name:RANGEL, TIFFANY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 GLENCARRON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2350
Mailing Address - Country:US
Mailing Address - Phone:239-851-2507
Mailing Address - Fax:
Practice Address - Street 1:5055 MARYLAND WAY STE 201
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7664
Practice Address - Country:US
Practice Address - Phone:615-590-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190311223G0001X
TNDS000000937511223G0001X
TNDS93751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice