Provider Demographics
NPI:1114112794
Name:MEYERS, TIMOTHY BERNARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BERNARD
Last Name:MEYERS
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 1:367 NH 120 UNIT B3
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1430
Mailing Address - Country:US
Mailing Address - Phone:603-643-6100
Mailing Address - Fax:
Practice Address - Street 1:367 NH 120 UNIT B3
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1430
Practice Address - Country:US
Practice Address - Phone:603-643-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03812122300000X
TX232321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist