Provider Demographics
NPI:1558689240
Name:WILLIAMS, TIFFANY L (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:WILLIAMS
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:PO BOX 980566
Mailing Address - Street 2:DENT: PEDIATRICS
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0566
Mailing Address - Country:US
Mailing Address - Phone:804-828-1790
Mailing Address - Fax:804-827-0163
Practice Address - Street 1:521 N 11TH ST RM 317
Practice Address - Street 2:DENT: PEDIATRICS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5045
Practice Address - Country:US
Practice Address - Phone:804-828-1790
Practice Address - Fax:804-827-0163
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAC5385578-R6141223G0001X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice