Provider Demographics
NPI:1437464849
Name:TIMOTHY J. ITEN, D.D.S., INC.
Entity Type:Organization
Organization Name:TIMOTHY J. ITEN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ITEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-522-5437
Mailing Address - Street 1:245 STERKEL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1507
Mailing Address - Country:US
Mailing Address - Phone:419-522-5437
Mailing Address - Fax:419-522-1631
Practice Address - Street 1:245 STERKEL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1507
Practice Address - Country:US
Practice Address - Phone:419-522-5437
Practice Address - Fax:419-522-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty