Provider Demographics
NPI:1346425493
Name:CHIMELAK, TIFFENY M (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFENY
Middle Name:M
Last Name:CHIMELAK
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 1:300 E LONG LAKE
Mailing Address - Street 2:STE 311 GREAT EXPRESSIONS DENTAL CENTERS
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-203-1119
Mailing Address - Fax:248-723-0052
Practice Address - Street 1:2425 EAST TWELVE MILE RD
Practice Address - Street 2:GREAT EXPRESSIONS DENTAL CENTERS
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092
Practice Address - Country:US
Practice Address - Phone:586-573-7334
Practice Address - Fax:586-573-4853
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist