Provider Demographics
NPI:1013580141
Name:DR.PETER TIMM #1, PLLC
Entity Type:Organization
Organization Name:DR.PETER TIMM #1, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-720-8090
Mailing Address - Street 1:2300 S MASON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6268
Mailing Address - Country:US
Mailing Address - Phone:281-720-8090
Mailing Address - Fax:281-720-8091
Practice Address - Street 1:2300 S MASON RD STE 104
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6268
Practice Address - Country:US
Practice Address - Phone:281-720-8090
Practice Address - Fax:281-720-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental