Provider Demographics
NPI:1679702765
Name:GAVIN WALKER, TIFFANY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:D
Last Name:GAVIN WALKER
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:12520 PROSPERITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1664
Mailing Address - Country:US
Mailing Address - Phone:301-989-8991
Mailing Address - Fax:301-989-2434
Practice Address - Street 1:12520 PROSPERITY DR STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1664
Practice Address - Country:US
Practice Address - Phone:301-989-8991
Practice Address - Fax:301-989-2434
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY05292911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry