Provider Demographics
NPI:1083775795
Name:MONROE, TIMOTHY VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:VINCENT
Last Name:MONROE
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 1:410 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1819
Mailing Address - Country:US
Mailing Address - Phone:740-594-8207
Mailing Address - Fax:740-592-5931
Practice Address - Street 1:410 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1819
Practice Address - Country:US
Practice Address - Phone:740-594-8207
Practice Address - Fax:740-592-5931
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery