Provider Demographics
NPI:1760229355
Name:SHEROCK, TIFFANY LEE (DDS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:SHEROCK
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 1:595 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-8126
Mailing Address - Country:US
Mailing Address - Phone:586-215-8982
Mailing Address - Fax:
Practice Address - Street 1:827 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-9333
Practice Address - Country:US
Practice Address - Phone:319-499-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist