Provider Demographics
NPI:1689692204
Name:TIMOTHY W. GIFFORD, DDS, INC
Entity Type:Organization
Organization Name:TIMOTHY W. GIFFORD, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-578-6400
Mailing Address - Street 1:5595 WINFIELD BLVD
Mailing Address - Street 2:208
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1220
Mailing Address - Country:US
Mailing Address - Phone:408-578-6400
Mailing Address - Fax:408-578-0641
Practice Address - Street 1:5595 WINFIELD BLVD
Practice Address - Street 2:208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1220
Practice Address - Country:US
Practice Address - Phone:408-578-6400
Practice Address - Fax:408-578-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty