Tiffany Simon Kondoff, DDS, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

TIFFANY SIMON KONDOFF, DDS, PLLC

Doing business as

Cedar Park Premier Dentistry

Practice address

209 Denali Pass Ste B
Cedar Park, TX 78613-7500

Phone

(512) 782-0821

Fax

(866) 217-8281

NPI assigned

Oct 26, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kayla Edwards

Title

Insurance Coordinator

Phone

(512) 782-0821

Specialties & licenses 1

Addresses

Other names 1

• Cedar Park Premier Dentistry Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Drayton Ince, DDS

  • Dentist
  • Cedar Park, TX
  • NPI 1821193665
  NPD (past)
• Jay Jerald Jensen, D.D.S.

  • General Practice Dentistry
  • Cedar Park, TX
  • NPI 1962547125
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1922870690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 DENALI PASS STE B",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786137500",
            "telephone_number": "512-782-0821",
            "fax_number": "866-217-8281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 DENALI PASS STE B",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786137500",
            "telephone_number": "512-782-0821",
            "fax_number": "866-217-8281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFFANY SIMON KONDOFF, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "KAYLA",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "512-782-0821"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Park Premier Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rhea Thomas, BCBA
• Emily Thompson, AUD
• Bonnie Thomson, FNP
• Laura Thoreson, PSY.D
• Kimberly Sue Throckmorton, AUD
• Diba Tillery, RN, IBCLC
• Tillman Physical Therapy & Sports Training
• Tillman Physical Therapy & Sports Training Center, Inc
• Michael Ray Tillman, MPT, CSCS, CERT, MDT
• Michelle L Tilton

• Dental Clinic/Center in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.