Provider Demographics
NPI:1720288004
Name:BASS, TIFFANY IRENE (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:IRENE
Last Name:BASS
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 1:1019 PACIFIC AVE STE 300
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4488
Mailing Address - Country:US
Mailing Address - Phone:253-597-4550
Mailing Address - Fax:253-597-4556
Practice Address - Street 1:1708 E 44TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4611
Practice Address - Country:US
Practice Address - Phone:253-572-7002
Practice Address - Fax:253-593-2854
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice