Provider Demographics
NPI:1932645827
Name:LEE, TIFFANY KAFEI (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KAFEI
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E CENTENNIAL PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-5605
Mailing Address - Country:US
Mailing Address - Phone:702-991-0404
Mailing Address - Fax:
Practice Address - Street 1:2345 E CENTENNIAL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-5605
Practice Address - Country:US
Practice Address - Phone:702-991-0404
Practice Address - Fax:702-991-0404
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630031223P0700X
NVS5-46C1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics