Provider Demographics
NPI:1487829602
Name:TIMPSON, CORRY LARSEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORRY
Middle Name:LARSEN
Last Name:TIMPSON
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 1:1525 WARM SPRINGS RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-454-0818
Mailing Address - Fax:702-454-3716
Practice Address - Street 1:1525 WARM SPRINGS RD
Practice Address - Street 2:SUITE #100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-454-0818
Practice Address - Fax:702-454-3716
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV28211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice