Provider Demographics
NPI:1043627318
Name:TIMOTHY R. GAROFOLO, DDS INC
Entity Type:Organization
Organization Name:TIMOTHY R. GAROFOLO, DDS INC
Other - Org Name:SAN DIEGO DENTISTRY STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAROFOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-451-2555
Mailing Address - Street 1:11610 IBERIA PL STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2453
Mailing Address - Country:US
Mailing Address - Phone:858-451-2555
Mailing Address - Fax:
Practice Address - Street 1:11610 IBERIA PL STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2453
Practice Address - Country:US
Practice Address - Phone:858-451-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty