Provider Demographics
NPI:1164018693
Name:DR. TIMOTHY J. WACHUTA
Entity Type:Organization
Organization Name:DR. TIMOTHY J. WACHUTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WACHUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-425-5100
Mailing Address - Street 1:8850 W 38TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4245
Mailing Address - Country:US
Mailing Address - Phone:303-425-5100
Mailing Address - Fax:303-424-9578
Practice Address - Street 1:8850 W 38TH AVE STE D
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4245
Practice Address - Country:US
Practice Address - Phone:303-425-5100
Practice Address - Fax:303-424-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental