Provider Demographics
NPI:1306026679
Name:ADAMS, TIMOTHY CID (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CID
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 DAMONTE RANCH PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-2989
Mailing Address - Country:US
Mailing Address - Phone:775-851-2204
Mailing Address - Fax:
Practice Address - Street 1:59 DAMONTE RANCH PKWY STE F
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2989
Practice Address - Country:US
Practice Address - Phone:775-851-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56428122300000X
NVS7-88C1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist