Provider Demographics
NPI:1679720247
Name:DUDLEY, TIFFANY MELISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MELISSA
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:MELISSA
Other - Last Name:STAFIEJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3911 W. ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-498-0050
Mailing Address - Fax:561-498-0841
Practice Address - Street 1:3911 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3902
Practice Address - Country:US
Practice Address - Phone:561-498-0050
Practice Address - Fax:561-498-0841
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18099122300000X
MI2901019615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist