Provider Demographics
NPI:1417112335
Name:VOSTERS, TIMOTHY JAY (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAY
Last Name:VOSTERS
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 1:2214 E EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9002
Mailing Address - Country:US
Mailing Address - Phone:920-739-3936
Mailing Address - Fax:920-882-8653
Practice Address - Street 1:2214 E EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9002
Practice Address - Country:US
Practice Address - Phone:920-739-3936
Practice Address - Fax:920-882-8653
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3583-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist