Provider Demographics
NPI:1467008979
Name:VISGER, TIMOTHY CHARLES
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:VISGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1219
Mailing Address - Country:US
Mailing Address - Phone:740-922-2846
Mailing Address - Fax:740-264-6812
Practice Address - Street 1:401 GRANT ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1219
Practice Address - Country:US
Practice Address - Phone:740-922-2846
Practice Address - Fax:740-264-6812
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist