Provider Demographics
NPI:1477110302
Name:NIQUETTE, TIFFANY THANH NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:THANH NGUYEN
Last Name:NIQUETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:THANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:19700 E PARKER SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7301
Mailing Address - Country:US
Mailing Address - Phone:720-605-1696
Mailing Address - Fax:
Practice Address - Street 1:19700 E PARKER SQUARE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7301
Practice Address - Country:US
Practice Address - Phone:720-605-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS614211223G0001X
CO002039881223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice