Provider Demographics
NPI:1750501854
Name:KAERCHER, TIMOTHY JM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JM
Last Name:KAERCHER
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 1:32 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-2414
Mailing Address - Country:US
Mailing Address - Phone:518-235-7843
Mailing Address - Fax:518-235-7843
Practice Address - Street 1:32 BROAD STREET
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-2414
Practice Address - Country:US
Practice Address - Phone:518-235-7843
Practice Address - Fax:518-235-7843
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03064311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000460199001OtherBLUE SHIELD OF NE NY