Provider Demographics
NPI:1710490511
Name:ELSEY, TIFFANY LEANN (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:LEANN
Last Name:ELSEY
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:LEANN
Other - Last Name:SUNDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENTAL ASSISTANT
Mailing Address - Street 1:4655 OMAHA BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4655 OMAHA BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-1914
Practice Address - Country:US
Practice Address - Phone:843-743-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant