Provider Demographics
NPI:1639483654
Name:BAL, TIFFANY HONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:HONG
Last Name:BAL
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 1:750 OAK AVENUE PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-984-8100
Mailing Address - Fax:916-984-8110
Practice Address - Street 1:750 OAK AVENUE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-8100
Practice Address - Fax:916-984-8110
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist