Provider Demographics
NPI:1164438339
Name:TIMMERMAN, LANCE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:B
Last Name:TIMMERMAN
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 1:7100 FORT DENT WAY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-7500
Mailing Address - Country:US
Mailing Address - Phone:206-241-5533
Mailing Address - Fax:206-241-5538
Practice Address - Street 1:7100 FORT DENT WAY
Practice Address - Street 2:SUITE 270
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-7500
Practice Address - Country:US
Practice Address - Phone:206-241-5533
Practice Address - Fax:206-241-5538
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA82291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice