Provider Demographics
NPI:1275621583
Name:SCHEETZ, TIMOTHY DEREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DEREK
Last Name:SCHEETZ
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 1:710 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3018
Mailing Address - Country:US
Mailing Address - Phone:919-663-2732
Mailing Address - Fax:919-663-3190
Practice Address - Street 1:710 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3018
Practice Address - Country:US
Practice Address - Phone:919-663-2732
Practice Address - Fax:919-663-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997584Medicaid