Provider Demographics
NPI:1851562037
Name:DR. TIMOTHY M. RECTOR DDS PA
Entity Type:Organization
Organization Name:DR. TIMOTHY M. RECTOR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-246-4151
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-1833
Mailing Address - Country:US
Mailing Address - Phone:336-246-4151
Mailing Address - Fax:336-846-2463
Practice Address - Street 1:#3 STATE STREET
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-1833
Practice Address - Country:US
Practice Address - Phone:336-246-4151
Practice Address - Fax:336-846-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899009JMedicaid