Provider Demographics
NPI:1659676302
Name:GO, TIFFANY A (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:GO
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 1:1002 PARK AVE N
Mailing Address - Street 2:SUITE K
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 PARK AVE N
Practice Address - Street 2:SUITE K
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5632
Practice Address - Country:US
Practice Address - Phone:425-226-1990
Practice Address - Fax:425-228-6806
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE6019224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist