Provider Demographics
NPI:1720334469
Name:MALDONADO, TIFFANY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LEE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:LEE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:3024 MOUNTAIN VIEW DR STE 107
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3141
Mailing Address - Country:US
Mailing Address - Phone:907-312-5479
Mailing Address - Fax:
Practice Address - Street 1:3024 MOUNTAIN VIEW DR STE 107
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3141
Practice Address - Country:US
Practice Address - Phone:907-312-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415690122300000X
TX11759124Q00000X
NMDH3737124Q00000X
AK1637091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist