Provider Demographics
NPI:1124213517
Name:KITLEY, TIMOTHY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:KITLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E OGDEN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1283
Mailing Address - Country:US
Mailing Address - Phone:630-986-1234
Mailing Address - Fax:630-828-2984
Practice Address - Street 1:700 E OGDEN AVE
Practice Address - Street 2:STE 110
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1283
Practice Address - Country:US
Practice Address - Phone:630-986-1234
Practice Address - Fax:630-828-2984
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190306471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry