Provider Demographics
NPI:1689653529
Name:CRAEMER, TIMOTHY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:CRAEMER
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:BLDG 9900, 2ND FLOOR
Mailing Address - Street 2:U.S. ARMY DENTAL ACTIVITY - FT LEWIS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4039
Mailing Address - Fax:253-868-5919
Practice Address - Street 1:BLDG 9900, 2ND FLOOR
Practice Address - Street 2:U.S. ARMY DENTAL ACTIVITY - FT LEWIS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4039
Practice Address - Fax:253-868-5919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0142761223P0300X
WADE000071241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics