Provider Demographics
NPI:1841445590
Name:SUN, TIFFANIE J (DDS)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:J
Last Name:SUN
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 1:1520 W EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1921
Mailing Address - Country:US
Mailing Address - Phone:916-921-6051
Mailing Address - Fax:916-921-6480
Practice Address - Street 1:1954 DEL PASO RD STE 142
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-7707
Practice Address - Country:US
Practice Address - Phone:916-921-6051
Practice Address - Fax:916-921-6480
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice