Provider Demographics
NPI:1336675784
Name:OWEN AND TIMOCK ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:OWEN AND TIMOCK ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:913-568-1275
Mailing Address - Street 1:3221 EASTBROOK DR
Mailing Address - Street 2:BUILDING A SUITE 103
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5708
Mailing Address - Country:US
Mailing Address - Phone:970-484-4102
Mailing Address - Fax:970-484-1591
Practice Address - Street 1:3221 EASTBROOK DR
Practice Address - Street 2:BUILDING A SUITE 103
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5708
Practice Address - Country:US
Practice Address - Phone:970-484-4102
Practice Address - Fax:970-484-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92591223X0400X
CO102981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty