Provider Demographics
NPI:1851413744
Name:NUSBAUM, TIMOTHY G (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:NUSBAUM
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 1:1140 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1174
Mailing Address - Country:US
Mailing Address - Phone:740-773-8320
Mailing Address - Fax:740-773-8321
Practice Address - Street 1:1140 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1174
Practice Address - Country:US
Practice Address - Phone:740-773-8320
Practice Address - Fax:740-773-8321
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0150701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0311237Medicaid