Provider Demographics
NPI:1972735611
Name:MONCRIEFFE, TIFFANY IRIS (DMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:IRIS
Last Name:MONCRIEFFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:IRIS
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3291 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-5603
Mailing Address - Country:US
Mailing Address - Phone:718-801-0187
Mailing Address - Fax:
Practice Address - Street 1:3291 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-5603
Practice Address - Country:US
Practice Address - Phone:718-801-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0545491223G0001X
FLDN 210231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice