Provider Demographics
NPI:1588654446
Name:BOEYINK, TIMOTHY (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BOEYINK
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 1:7900 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-5102
Mailing Address - Country:US
Mailing Address - Phone:720-489-7333
Mailing Address - Fax:
Practice Address - Street 1:7900 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-5102
Practice Address - Country:US
Practice Address - Phone:720-489-7333
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice