Provider Demographics
NPI:1942383534
Name:CASEY, TIMOTHY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:CASEY
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 1:22910 E APPLEWAY
Mailing Address - Street 2:#5
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019
Mailing Address - Country:US
Mailing Address - Phone:509-927-9279
Mailing Address - Fax:509-927-9278
Practice Address - Street 1:22011 E COUNTRY VISTA DR STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5242
Practice Address - Country:US
Practice Address - Phone:509-927-9279
Practice Address - Fax:509-927-9278
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036710Medicaid