Provider Demographics
NPI:1275893620
Name:TIMIN, DARYA
Entity Type:Individual
Prefix:MISS
First Name:DARYA
Middle Name:
Last Name:TIMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 MCKINNON ST APT 5112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1052
Mailing Address - Country:US
Mailing Address - Phone:917-499-8840
Mailing Address - Fax:
Practice Address - Street 1:2820 MCKINNON ST APT 5112
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1052
Practice Address - Country:US
Practice Address - Phone:917-499-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist