Individual
TIFFANY STICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6323 N FRESNO ST, 101, FRESNO, CA 93710-5282
(559) 439-2607
Mailing address
1711 FOWLER AVE, CLOVIS, CA 93611-3001
(559) 579-5513
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
81382
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81382
DENTAL ASSISTANT
CA
Enumeration date
05/08/2015
Last updated
05/08/2015
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