Provider Demographics
NPI:1871282293
Name:SMITH, TIFFANY TIANA (DDS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TIANA
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HARRISON AVE UNIT 1024
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3771
Mailing Address - Country:US
Mailing Address - Phone:570-575-6898
Mailing Address - Fax:
Practice Address - Street 1:228 GREAT RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2216
Practice Address - Country:US
Practice Address - Phone:978-391-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1860061122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program