Provider Demographics
NPI:1679821078
Name:CHAFFEE, TIMOTHY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 LAKE TAPPS PKWY SE
Mailing Address - Street 2:SUITE A103
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8156
Mailing Address - Country:US
Mailing Address - Phone:253-288-3078
Mailing Address - Fax:
Practice Address - Street 1:1404 LAKE TAPPS PKWY SE
Practice Address - Street 2:SUITE A103
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8156
Practice Address - Country:US
Practice Address - Phone:253-288-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60397826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist