Provider Demographics
NPI:1407204126
Name:SMITH, TIFFANY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LYNN
Last Name:SMITH
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 1:1189 PINEVIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0479
Mailing Address - Country:US
Mailing Address - Phone:304-598-2030
Mailing Address - Fax:
Practice Address - Street 1:1189 PINEVIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0479
Practice Address - Country:US
Practice Address - Phone:304-598-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice