Provider Demographics
NPI:1013355668
Name:TIFFANY DUSHANE, D.M.D, INC.
Entity Type:Organization
Organization Name:TIFFANY DUSHANE, D.M.D, INC.
Other - Org Name:DUSHANE DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-533-4528
Mailing Address - Street 1:9201 W SUNSET BLVD STE 808
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3709
Mailing Address - Country:US
Mailing Address - Phone:310-739-1113
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 808
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3709
Practice Address - Country:US
Practice Address - Phone:310-739-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty