Provider Demographics
NPI:1598885022
Name:GEFFERT, TIM ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:ALAN
Last Name:GEFFERT
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 1:801 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3159
Mailing Address - Country:US
Mailing Address - Phone:361-992-5533
Mailing Address - Fax:361-992-2999
Practice Address - Street 1:801 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3159
Practice Address - Country:US
Practice Address - Phone:361-992-5533
Practice Address - Fax:361-992-2999
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB13180-1OtherHHSC