Provider Demographics
NPI:1942368766
Name:TIMM, TERRY (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:TIMM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1327
Mailing Address - Country:US
Mailing Address - Phone:734-429-5433
Mailing Address - Fax:734-429-5033
Practice Address - Street 1:214 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1327
Practice Address - Country:US
Practice Address - Phone:734-429-5433
Practice Address - Fax:734-429-5033
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI96611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics