Provider Demographics
NPI:1366938466
Name:YARBROUGH, TIANNE (DDS)
Entity type:Individual
Prefix:
First Name:TIANNE
Middle Name:
Last Name:YARBROUGH
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 1:4111 COLE AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1533
Mailing Address - Country:US
Mailing Address - Phone:806-367-8115
Mailing Address - Fax:
Practice Address - Street 1:4400 HERITAGE TRACE PKWY STE 212
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8902
Practice Address - Country:US
Practice Address - Phone:817-482-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice