Provider Demographics
NPI:1700524212
Name:NAZAR, TIFFANY (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NAZAR
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 1:1100 ALTA LOMA RD APT 701
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2438
Mailing Address - Country:US
Mailing Address - Phone:310-806-0593
Mailing Address - Fax:
Practice Address - Street 1:1100 ALTA LOMA RD APT 701
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2438
Practice Address - Country:US
Practice Address - Phone:310-806-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS107149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist