Provider Demographics
NPI:1841789468
Name:JACOBS, TIFFANY JULIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:JULIANA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:JULIANA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10712 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5286
Mailing Address - Country:US
Mailing Address - Phone:202-701-0916
Mailing Address - Fax:
Practice Address - Street 1:309 NE 103RD ST STE 2B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7100
Practice Address - Country:US
Practice Address - Phone:206-452-2200
Practice Address - Fax:206-452-7700
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18585941223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program