Provider Demographics
NPI:1225767510
Name:BLESSIE, TIFFANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:
Last Name:BLESSIE
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 1:2177 S MCQUEEN RD APT 3092
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1852
Mailing Address - Country:US
Mailing Address - Phone:815-579-4318
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9140
Practice Address - Country:US
Practice Address - Phone:480-893-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0114201223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health