Provider Demographics
NPI:1114102357
Name:GIFFORD, TIMOTHY W (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:GIFFORD
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 1:5595 WINFIELD BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1220
Mailing Address - Country:US
Mailing Address - Phone:408-578-6400
Mailing Address - Fax:408-578-0641
Practice Address - Street 1:5595 WINFIELD BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1220
Practice Address - Country:US
Practice Address - Phone:408-578-6400
Practice Address - Fax:408-578-0641
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics