Provider Demographics
NPI:1710117221
Name:NORDLOFF, TIMOTHY A (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:NORDLOFF
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8577
Mailing Address - Country:US
Mailing Address - Phone:408-655-8069
Mailing Address - Fax:
Practice Address - Street 1:546 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4326
Practice Address - Country:US
Practice Address - Phone:831-247-3934
Practice Address - Fax:831-783-1219
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1843711223S0112X
CA1076611223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty