Provider Demographics
NPI:1912914219
Name:ALLEN-EVANS, TIFFINIE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFINIE
Middle Name:A
Last Name:ALLEN-EVANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TIFFINIE
Other - Middle Name:A
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:9618 GUNNIES DR
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-1107
Mailing Address - Country:US
Mailing Address - Phone:865-978-7646
Mailing Address - Fax:
Practice Address - Street 1:9618 GUNNIES DR
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-1107
Practice Address - Country:US
Practice Address - Phone:865-978-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17621122300000X
TN8848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist