Provider Demographics
NPI:1275902934
Name:GEORGIEFSKI, TIFFANY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:GEORGIEFSKI
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 1:1704 IRELAND DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2831
Mailing Address - Country:US
Mailing Address - Phone:512-260-3303
Mailing Address - Fax:
Practice Address - Street 1:14933 W STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4323
Practice Address - Country:US
Practice Address - Phone:512-515-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice