Provider Demographics
NPI:1346273109
Name:ENTWISTLE, TIMOTHY (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ENTWISTLE
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 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-295-1890
Mailing Address - Fax:585-295-1898
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-295-1890
Practice Address - Fax:585-295-1898
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0517311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice