Provider Demographics
NPI:1023498987
Name:HOLLINGSWORTH, TIFFANY THOMAS (DMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:THOMAS
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 FOOTE ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4911
Mailing Address - Country:US
Mailing Address - Phone:662-287-3156
Mailing Address - Fax:662-287-3157
Practice Address - Street 1:1025 FOOTE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4911
Practice Address - Country:US
Practice Address - Phone:662-287-3156
Practice Address - Fax:662-287-3157
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100411223G0001X
MS3798-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice