Provider Demographics
NPI:1598889362
Name:SHIFRIN, TATIANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:SHIFRIN
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 1:4229 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6389
Mailing Address - Country:US
Mailing Address - Phone:770-232-5255
Mailing Address - Fax:
Practice Address - Street 1:4229 PLEASANT HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6389
Practice Address - Country:US
Practice Address - Phone:770-232-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice