Provider Demographics
NPI:1225219439
Name:BRANTON, TIFFANI JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:JOY
Last Name:BRANTON
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 1:550 GREENACRES BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-747-6007
Mailing Address - Fax:318-747-9800
Practice Address - Street 1:550 GREENACRES BLVD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-747-6007
Practice Address - Fax:318-747-9800
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice