Provider Demographics
NPI:1013650134
Name:TONG, TIFFANY TRUC
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TRUC
Last Name:TONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NOYO HTS
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-4535
Mailing Address - Country:US
Mailing Address - Phone:408-368-9879
Mailing Address - Fax:
Practice Address - Street 1:119 NOYO HTS
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4535
Practice Address - Country:US
Practice Address - Phone:408-368-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist