Provider Demographics
NPI:1578637807
Name:LOVING, TIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
Last Name:LOVING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16930 E PALISADES BLVD
Mailing Address - Street 2:STE 109
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4006
Mailing Address - Country:US
Mailing Address - Phone:480-836-7600
Mailing Address - Fax:480-836-1502
Practice Address - Street 1:16930 E PALISADES BLVD
Practice Address - Street 2:STE 109
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4006
Practice Address - Country:US
Practice Address - Phone:480-836-7600
Practice Address - Fax:480-836-1502
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice