Provider Demographics
NPI:1669705935
Name:SRECA, TIFFANY YOUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:YOUNG
Last Name:SRECA
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 1:2534 GENESEE ST
Mailing Address - Street 2:THE CENTER FOR COMPREHENSIVE DENTISTRY
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5814
Mailing Address - Country:US
Mailing Address - Phone:315-724-5141
Mailing Address - Fax:
Practice Address - Street 1:2534 GENESEE ST
Practice Address - Street 2:THE CENTER FOR COMPREHENSIVE DENTISTRY
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5814
Practice Address - Country:US
Practice Address - Phone:315-724-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055997-11223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice