Provider Demographics
NPI:1992913743
Name:PHI, TIFFANY (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:PHI
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 1:470 NAUTILUS ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5969
Mailing Address - Country:US
Mailing Address - Phone:858-454-5822
Mailing Address - Fax:858-454-4727
Practice Address - Street 1:470 NAUTILUS ST
Practice Address - Street 2:SUITE 309
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5969
Practice Address - Country:US
Practice Address - Phone:858-454-5822
Practice Address - Fax:858-454-4727
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice