Provider Demographics
NPI:1891274122
Name:TIMBERLINE ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:TIMBERLINE ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRONSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLIEP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:402-314-5132
Mailing Address - Street 1:112 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4694
Mailing Address - Country:US
Mailing Address - Phone:402-314-5132
Mailing Address - Fax:
Practice Address - Street 1:1424 E HORSETOOTH RD STE 1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5726
Practice Address - Country:US
Practice Address - Phone:970-223-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203592261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental