Basic Information
| Provider Information | |||||||||
| NPI: | 1104155647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORR | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 KRAMER LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787584013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1210 W BRAKER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787583801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789880 | ||||||||
| FaxNumber: | 5122792556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2009 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 58986 | CA | N | Dental Providers | Dentist | General Practice | 1223D0001X | 31822 | TX | Y | Dental Providers | Dentist | Dental Public Health |
No ID Information.