Provider Demographics
NPI:1578811667
Name:GARRISON-JETER, TIFFANIE LASHAUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANIE
Middle Name:LASHAUN
Last Name:GARRISON-JETER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6998 OLD CUSSETA RD
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5431
Mailing Address - Country:US
Mailing Address - Phone:706-544-3176
Mailing Address - Fax:706-544-1933
Practice Address - Street 1:6998 OLD CUSSETA RD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5431
Practice Address - Country:US
Practice Address - Phone:706-544-3176
Practice Address - Fax:706-544-1933
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9488122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice