Provider Demographics
NPI:1811191695
Name:SINNER, TIMOTHY HARRISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HARRISON
Last Name:SINNER
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 1:1209 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5601
Mailing Address - Country:US
Mailing Address - Phone:701-252-6005
Mailing Address - Fax:
Practice Address - Street 1:1209 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5601
Practice Address - Country:US
Practice Address - Phone:701-252-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16901223G0001X
WI2941-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41256Medicaid