Provider Demographics
NPI:1326482951
Name:MCCARTHY, TIFFANY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:MCCARTHY
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 1:4078 BEAUBEIN DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6424
Mailing Address - Country:US
Mailing Address - Phone:305-439-8241
Mailing Address - Fax:
Practice Address - Street 1:85 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2139
Practice Address - Country:US
Practice Address - Phone:716-672-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0581881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1326482951Medicaid