Provider Demographics
NPI:1649565342
Name:JENNINGS, TIMOTHY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:JENNINGS
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 1:2859 E FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2312
Mailing Address - Country:US
Mailing Address - Phone:719-442-0071
Mailing Address - Fax:719-473-5303
Practice Address - Street 1:618 CHURCH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-2428
Practice Address - Country:US
Practice Address - Phone:615-750-0342
Practice Address - Fax:615-986-1705
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-10459122300000X
TX276731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist