Provider Demographics
NPI:1669670162
Name:WINBURN, TIFFANY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:WINBURN
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 1:2268 LYRICAL RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6529
Mailing Address - Country:US
Mailing Address - Phone:702-492-1615
Mailing Address - Fax:
Practice Address - Street 1:1621 E FLAMINGO RD
Practice Address - Street 2:SUITE 17-A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5276
Practice Address - Country:US
Practice Address - Phone:702-892-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice