Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D008051 | AZ |
NPI | 1043525736 |
---|---|
Provider Name | Tiffany Andersen |
First Address | Phoenix, AZ 85032-4548 |
Second Address | Glendale, AZ 85306-4645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 06/01/2020 |