Provider Demographics
NPI:1821115940
Name:SILLS, TIMOTHY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:SILLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LOCUST STREET
Mailing Address - Street 2:P O BOX 47
Mailing Address - City:OLD MONROE
Mailing Address - State:MO
Mailing Address - Zip Code:63369
Mailing Address - Country:US
Mailing Address - Phone:636-661-5205
Mailing Address - Fax:
Practice Address - Street 1:102 LOCUST ST
Practice Address - Street 2:
Practice Address - City:OLD MONROE
Practice Address - State:MO
Practice Address - Zip Code:63369
Practice Address - Country:US
Practice Address - Phone:636-661-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice