1083809404 NPI number — DR. TIFANI POSKEY SHUTTLESWORTH D.D.S.

Table of content: DR. TIFANI POSKEY SHUTTLESWORTH D.D.S. (NPI 1083809404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083809404 NPI number — DR. TIFANI POSKEY SHUTTLESWORTH D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUTTLESWORTH
Provider First Name:
TIFANI
Provider Middle Name:
POSKEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POSKEY
Provider Other First Name:
TIFANI
Provider Other Middle Name:
CARROLLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083809404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 STATE HIGHWAY 19 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75751-8966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-675-0023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 STATE HIGHWAY 19 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75751-8966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-675-0023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  23325 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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