Provider Demographics
NPI:1962132936
Name:SENSOLI, TIFFANY VALENCIA (DDS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VALENCIA
Last Name:SENSOLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JANE
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6225 SUMMIT CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1885
Mailing Address - Country:US
Mailing Address - Phone:734-646-3092
Mailing Address - Fax:
Practice Address - Street 1:6225 SUMMIT CT
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-1885
Practice Address - Country:US
Practice Address - Phone:734-646-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISTUDENT1223G0001X
MI2901601354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice