Provider Demographics
NPI:1619189677
Name:GLUPKER, TIMOTHY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:GLUPKER
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 1:203 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1701
Mailing Address - Country:US
Mailing Address - Phone:616-399-7110
Mailing Address - Fax:616-399-8630
Practice Address - Street 1:203 RILEY ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1701
Practice Address - Country:US
Practice Address - Phone:616-399-7110
Practice Address - Fax:616-399-8630
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010140831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics