Provider Demographics
NPI:1831602671
Name:DIFFNER, TONJA SUSANN (RDH)
Entity type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:SUSANN
Last Name:DIFFNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 N 172ND ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5511
Mailing Address - Country:US
Mailing Address - Phone:425-608-0055
Mailing Address - Fax:
Practice Address - Street 1:33919 9TH AVE S STE 1
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6724
Practice Address - Country:US
Practice Address - Phone:206-780-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60140200124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist