Provider Demographics
NPI:1265657225
Name:BACSA, TIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
Last Name:BACSA
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 1:5895 E THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2590
Mailing Address - Country:US
Mailing Address - Phone:317-784-5555
Mailing Address - Fax:317-333-7446
Practice Address - Street 1:5895 E THOMPSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2590
Practice Address - Country:US
Practice Address - Phone:317-784-5555
Practice Address - Fax:317-333-7446
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN19026831122300000X
IN12010741A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist