Provider Demographics
NPI:1861984247
Name:PINNIX, TIFFANY RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:RAE
Last Name:PINNIX
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 1:4631 TIMBERMILL CT APT 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3554
Mailing Address - Country:US
Mailing Address - Phone:828-446-6992
Mailing Address - Fax:
Practice Address - Street 1:70 CRAPE MYRTLE DR STE 104
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8034
Practice Address - Country:US
Practice Address - Phone:877-935-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist