Provider Demographics
NPI:1558404566
Name:O'CONNOR, TIMOTHY JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:O'CONNOR
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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-0870
Mailing Address - Country:US
Mailing Address - Phone:209-728-3305
Mailing Address - Fax:209-728-2957
Practice Address - Street 1:300 TOM BELL RD
Practice Address - Street 2:
Practice Address - City:MURPHYS
Practice Address - State:CA
Practice Address - Zip Code:95247
Practice Address - Country:US
Practice Address - Phone:209-728-3305
Practice Address - Fax:209-728-2957
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770304024OtherTIN