Provider Demographics
NPI:1619285970
Name:TIFFIN DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:TIFFIN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-7337
Mailing Address - Street 1:27 ST LAWRENCE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8312
Mailing Address - Country:US
Mailing Address - Phone:419-447-7337
Mailing Address - Fax:419-447-7003
Practice Address - Street 1:27 ST LAWRENCE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8312
Practice Address - Country:US
Practice Address - Phone:419-447-7337
Practice Address - Fax:419-447-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300222121223G0001X
OH300187841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty