Provider Demographics
NPI:1831509629
Name:WASHINGTON, TIFFANY MARIE PERKINS (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE PERKINS
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:25 ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-4007
Mailing Address - Country:US
Mailing Address - Phone:504-616-4724
Mailing Address - Fax:
Practice Address - Street 1:60 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8659
Practice Address - Country:US
Practice Address - Phone:504-616-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist