Provider Demographics
NPI:1114139789
Name:STROSTER, TIMOTHY G (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:G
Last Name:STROSTER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10192 GRAND RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6516
Mailing Address - Country:US
Mailing Address - Phone:810-220-1700
Mailing Address - Fax:810-220-1718
Practice Address - Street 1:10192 GRAND RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6516
Practice Address - Country:US
Practice Address - Phone:810-220-1700
Practice Address - Fax:810-220-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI150731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics