Provider Demographics
NPI:1275160707
Name:TIMOTHY J GLUPKER DDS
Entity Type:Organization
Organization Name:TIMOTHY J GLUPKER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GLUPKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-399-7110
Mailing Address - Street 1:203 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1701
Mailing Address - Country:US
Mailing Address - Phone:616-399-7110
Mailing Address - Fax:
Practice Address - Street 1:203 RILEY ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1701
Practice Address - Country:US
Practice Address - Phone:616-399-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty