Provider Demographics
NPI:1811385891
Name:ORCHID FAMILY DENTAL
Entity Type:Organization
Organization Name:ORCHID FAMILY DENTAL
Other - Org Name:TIFFANY JACOB DDS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:TRESA
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-424-3555
Mailing Address - Street 1:3555 MURPHY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-5215
Mailing Address - Country:US
Mailing Address - Phone:972-424-3555
Mailing Address - Fax:
Practice Address - Street 1:3555 MURPHY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-5215
Practice Address - Country:US
Practice Address - Phone:972-424-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty