Provider Demographics
NPI:1760601405
Name:ADAMS, TIMOTHY C (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:ADAMS
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 1:1040 N RANGELINE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1470
Mailing Address - Country:US
Mailing Address - Phone:317-580-9222
Mailing Address - Fax:317-580-9226
Practice Address - Street 1:1040 N RANGELINE RD STE B
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1470
Practice Address - Country:US
Practice Address - Phone:317-580-9222
Practice Address - Fax:317-580-9226
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008293A122300000X
AZ7690122300000X
NV4062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6351830001Medicare NSC