Provider Demographics
NPI:1003198615
Name:TIMBERS, CORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:TIMBERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N JACKSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1925
Mailing Address - Country:US
Mailing Address - Phone:408-251-3766
Mailing Address - Fax:
Practice Address - Street 1:155 N JACKSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1925
Practice Address - Country:US
Practice Address - Phone:408-251-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist