Provider Demographics
NPI:1609092444
Name:SCHWARTZ, TIMOTHY A (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:SCHWARTZ
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 1:2030 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-5430
Mailing Address - Country:US
Mailing Address - Phone:303-936-8204
Mailing Address - Fax:303-936-7073
Practice Address - Street 1:2030 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-5430
Practice Address - Country:US
Practice Address - Phone:303-936-8204
Practice Address - Fax:303-936-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD1-00714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02007144Medicaid