Provider Demographics
NPI:1609633684
Name:TIMOTHY PREWITT DDS INC
Entity Type:Organization
Organization Name:TIMOTHY PREWITT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-960-4878
Mailing Address - Street 1:1615 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2801
Mailing Address - Country:US
Mailing Address - Phone:559-875-3927
Mailing Address - Fax:559-875-0300
Practice Address - Street 1:37144 AVENUE 12 STE 104
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8709
Practice Address - Country:US
Practice Address - Phone:559-645-5320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty