Provider Demographics
NPI:1447565395
Name:MANZO JENKINS, TIFFANY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:N
Last Name:MANZO JENKINS
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 1:3585 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1111
Mailing Address - Country:US
Mailing Address - Phone:520-548-3361
Mailing Address - Fax:
Practice Address - Street 1:12495 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5288
Practice Address - Country:US
Practice Address - Phone:303-237-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist