Provider Demographics
NPI:1417153107
Name:STIRNEMAN, TIMOTHY D (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:STIRNEMAN
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 1:261 N RANDALL RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5999
Mailing Address - Country:US
Mailing Address - Phone:847-915-3080
Mailing Address - Fax:
Practice Address - Street 1:261 N RANDALL RD
Practice Address - Street 2:SUITE #102
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5999
Practice Address - Country:US
Practice Address - Phone:847-915-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist