Provider Demographics
NPI:1629784970
Name:TIMOTHY HARBIN DDS PLC
Entity Type:Organization
Organization Name:TIMOTHY HARBIN DDS PLC
Other - Org Name:TIMOTHY HARBIN DDS PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-448-2664
Mailing Address - Street 1:785 E M 32
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8790
Mailing Address - Country:US
Mailing Address - Phone:989-448-2664
Mailing Address - Fax:989-448-2666
Practice Address - Street 1:785 E M 32
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8790
Practice Address - Country:US
Practice Address - Phone:989-448-2664
Practice Address - Fax:989-448-2666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY HARBIN DDS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1194842468OtherKRISTAL GRENIUK-WIONCEK DDS