Provider Demographics
NPI:1912031337
Name:GOULD, TIMOTHY COCHRAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:COCHRAN
Last Name:GOULD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 RANDOM RD
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-9020
Mailing Address - Country:US
Mailing Address - Phone:814-664-0815
Mailing Address - Fax:
Practice Address - Street 1:33533 WEST 12 MILE ROAD SUITE 150
Practice Address - Street 2:SMILE PROGRAM
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331
Practice Address - Country:US
Practice Address - Phone:814-967-2276
Practice Address - Fax:814-967-3812
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022321L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist