Provider Demographics
NPI:1184844821
Name:KAUFMANN, TIMOTHY WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WALTER
Last Name:KAUFMANN
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:W1914 FAIRFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3204
Mailing Address - Country:US
Mailing Address - Phone:920-467-1485
Mailing Address - Fax:
Practice Address - Street 1:2819 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4118
Practice Address - Country:US
Practice Address - Phone:920-458-3455
Practice Address - Fax:920-208-4730
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5809-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice