Provider Demographics
NPI:1225182090
Name:AVEDOVECH, TIM R (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:R
Last Name:AVEDOVECH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:R
Other - Last Name:AVEDOVECH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2126 E ENID AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4512
Mailing Address - Country:US
Mailing Address - Phone:602-321-2414
Mailing Address - Fax:480-497-5162
Practice Address - Street 1:4035 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5219
Practice Address - Country:US
Practice Address - Phone:602-321-2414
Practice Address - Fax:480-497-5162
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15981223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics