Provider Demographics
NPI:1417174061
Name:SPALLONE, TIFFANY ANN (DMDPA)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANN
Last Name:SPALLONE
Suffix:
Gender:F
Credentials:DMDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966
Mailing Address - Country:US
Mailing Address - Phone:772-567-5100
Mailing Address - Fax:772-567-5801
Practice Address - Street 1:2166 58TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966
Practice Address - Country:US
Practice Address - Phone:772-567-5100
Practice Address - Fax:772-567-5801
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL154981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice