Provider Demographics
NPI:1902152812
Name:BOYD, TIFFANY CHANEL (RDH)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHANEL
Last Name:BOYD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13602 DANWOODS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4195
Mailing Address - Country:US
Mailing Address - Phone:804-986-7342
Mailing Address - Fax:
Practice Address - Street 1:13602 DANWOODS RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4195
Practice Address - Country:US
Practice Address - Phone:804-986-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203210124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist