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Individual
TIFFANY TAVARES
Active
Individual
TIFFANY TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, DMSC
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
36888
TX
125Q00000X
Oral Medicine Dentistry
2019034508
MO
125Q00000X
Oral Medicine Dentistry
Primary
36888
TX
Other
Enumeration date
09/06/2019
Last updated
11/21/2022
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