Provider Demographics
NPI:1417965088
Name:TIMM, JOHN TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TIMOTHY
Last Name:TIMM
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 1:700 EVERHART RD
Mailing Address - Street 2:SUITE B-11
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1926
Mailing Address - Country:US
Mailing Address - Phone:361-854-5181
Mailing Address - Fax:361-854-0741
Practice Address - Street 1:700 EVERHART RD
Practice Address - Street 2:SUITE B-11
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1926
Practice Address - Country:US
Practice Address - Phone:361-854-5181
Practice Address - Fax:361-854-0741
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802764OtherUNITED CONCORDIA