Provider Demographics
NPI:1417176934
Name:GOSSWEILER, TIMOTHY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:K
Last Name:GOSSWEILER
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 1:3511 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9775
Mailing Address - Country:US
Mailing Address - Phone:317-873-2755
Mailing Address - Fax:317-566-3302
Practice Address - Street 1:14904 GREYHOUND CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1091
Practice Address - Country:US
Practice Address - Phone:317-566-3300
Practice Address - Fax:317-566-3302
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009121A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist