Provider Demographics
NPI:1215212394
Name:LEMASTERS, TIFFANY NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:LEMASTERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25708-0327
Mailing Address - Country:US
Mailing Address - Phone:304-429-1088
Mailing Address - Fax:304-429-3109
Practice Address - Street 1:1423 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1614
Practice Address - Country:US
Practice Address - Phone:304-691-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0259261223G0001X
WV39711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022482Medicaid
WVWV0925BMedicare PIN
WVWV0925AMedicare PIN
WVWV0925EMedicare PIN
WV3810022482Medicaid
WVWV0925DMedicare PIN
WVWV0925CMedicare PIN
WVWV0925IMedicare Oscar/Certification
WVWV0925HMedicare Oscar/Certification
WVWV0925FMedicare PIN
WVWV0925B662Medicare Oscar/Certification