Provider Demographics
NPI:1336125913
Name:VERNY, TIMOTHY DIMITRI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DIMITRI
Last Name:VERNY
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 1:13935 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7001
Mailing Address - Country:US
Mailing Address - Phone:310-973-6428
Mailing Address - Fax:310-973-5395
Practice Address - Street 1:13935 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7001
Practice Address - Country:US
Practice Address - Phone:310-973-6428
Practice Address - Fax:310-973-5395
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48778122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48778OtherDENTICAL PROVIDER NUMBER