Provider Demographics
NPI:1104264266
Name:TEEGARDEN, TIFFANY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE
Last Name:TEEGARDEN
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 1:548 SE COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-5499
Mailing Address - Country:US
Mailing Address - Phone:620-770-2620
Mailing Address - Fax:
Practice Address - Street 1:1215 N 7 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2281
Practice Address - Country:US
Practice Address - Phone:816-427-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016361122300000X, 122300000X
IADDS-09027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist