Provider Demographics
NPI:1033542725
Name:LANCE TIMMERMAN DMDPS
Entity Type:Organization
Organization Name:LANCE TIMMERMAN DMDPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:TIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-241-5533
Mailing Address - Street 1:7100 FORT DENT WAY
Mailing Address - Street 2:SUITE #270
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-7500
Mailing Address - Country:US
Mailing Address - Phone:206-241-5533
Mailing Address - Fax:206-241-5538
Practice Address - Street 1:7100 FORT DENT WAY
Practice Address - Street 2:SUITE #270
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-7500
Practice Address - Country:US
Practice Address - Phone:206-241-5533
Practice Address - Fax:206-241-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8229122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty