Provider Demographics
NPI:1871689133
Name:GRINDER, TIMOTHY M (DDS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:M
Last Name:GRINDER
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 1:201 VICTOR HUGO DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-388-9122
Mailing Address - Fax:919-851-8986
Practice Address - Street 1:580 NEW WAVERLY PL
Practice Address - Street 2:210
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7406
Practice Address - Country:US
Practice Address - Phone:919-851-1040
Practice Address - Fax:919-851-8986
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93439OtherBLUE CROSS BLUE SHIELD
570722OtherUNITED CONCORIDA INS