Provider Demographics
NPI:1598773764
Name:MCNAMARA, TIMOTHY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:MCNAMARA
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 1:8405 W FOREST HOME AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3407
Mailing Address - Country:US
Mailing Address - Phone:414-425-7710
Mailing Address - Fax:414-425-7424
Practice Address - Street 1:8405 W FOREST HOME AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3407
Practice Address - Country:US
Practice Address - Phone:414-425-7710
Practice Address - Fax:414-425-7424
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI77968Medicare ID - Type Unspecified