Provider Demographics
NPI:1902415003
Name:PINKSTON, TIFFANY (DMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1419
Mailing Address - Country:US
Mailing Address - Phone:316-722-7331
Mailing Address - Fax:316-722-7586
Practice Address - Street 1:8833 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1419
Practice Address - Country:US
Practice Address - Phone:316-722-7331
Practice Address - Fax:316-722-7586
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist