Provider Demographics
NPI:1891909982
Name:METTLER, TIMOTHY MARLIN (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARLIN
Last Name:METTLER
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 1:7505 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2107
Mailing Address - Country:US
Mailing Address - Phone:623-487-4870
Mailing Address - Fax:623-979-8737
Practice Address - Street 1:7505 W DEER VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2107
Practice Address - Country:US
Practice Address - Phone:623-487-4870
Practice Address - Fax:623-979-8737
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ30271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD03027OtherBODEX
AZAZ3027OtherSTATE LICENSE