Provider Demographics
NPI:1659578961
Name:ALEM, TIMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMAR
Middle Name:
Last Name:ALEM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 N. 185TH ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-417-6453
Mailing Address - Fax:206-417-6455
Practice Address - Street 1:510 19TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4095
Practice Address - Country:US
Practice Address - Phone:206-299-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7477122300000X
WADE00007477122300000X
WA00007477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5031018Medicaid