Provider Demographics
NPI:1801969464
Name:WINFREY, TIFFANIE C (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANIE
Middle Name:C
Last Name:WINFREY
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 1:13900 LAUREL LAKES AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5091
Mailing Address - Country:US
Mailing Address - Phone:301-483-6767
Mailing Address - Fax:301-483-6765
Practice Address - Street 1:13900 LAUREL LAKES AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5091
Practice Address - Country:US
Practice Address - Phone:301-483-6767
Practice Address - Fax:301-483-6765
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice