Provider Demographics
NPI:1487027702
Name:KERNS, TIFFANY RUTH (RDH)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:RUTH
Last Name:KERNS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3177 COUNTY ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATUS
Mailing Address - State:NY
Mailing Address - Zip Code:13040-9599
Mailing Address - Country:US
Mailing Address - Phone:607-745-8848
Mailing Address - Fax:
Practice Address - Street 1:3177 COUNTY ROUTE 2
Practice Address - Street 2:
Practice Address - City:CINCINNATUS
Practice Address - State:NY
Practice Address - Zip Code:13040-9599
Practice Address - Country:US
Practice Address - Phone:607-745-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023247124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist