Provider Demographics
NPI:1184077620
Name:MCPHEETERS, TIFFANY GARRETT (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:GARRETT
Last Name:MCPHEETERS
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 1:3510 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4604
Mailing Address - Country:US
Mailing Address - Phone:502-442-7185
Mailing Address - Fax:
Practice Address - Street 1:3510 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4604
Practice Address - Country:US
Practice Address - Phone:502-442-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY98321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice