Provider Demographics
NPI:1700922788
Name:HARTMAN, TIFFANY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:P
Last Name:HARTMAN
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 1:601 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-0000
Mailing Address - Country:US
Mailing Address - Phone:307-534-1988
Mailing Address - Fax:307-534-1987
Practice Address - Street 1:601 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-0000
Practice Address - Country:US
Practice Address - Phone:307-534-1988
Practice Address - Fax:307-534-1987
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice