Provider Demographics
NPI:1023198033
Name:SINES, TIMOTHY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:SINES
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 1:1193 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0481
Mailing Address - Country:US
Mailing Address - Phone:304-599-8250
Mailing Address - Fax:301-729-0404
Practice Address - Street 1:1193 PINEVIEW DR STE A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3395
Practice Address - Country:US
Practice Address - Phone:304-599-8250
Practice Address - Fax:304-599-6684
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD658700300Medicaid