Provider Demographics
NPI:1942515952
Name:RAUCH, TIMOTHY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:RAUCH
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 1:222.5 SAN AUGUSTINE WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066
Mailing Address - Country:US
Mailing Address - Phone:505-377-7012
Mailing Address - Fax:
Practice Address - Street 1:930 SUNNYSLOPE RD
Practice Address - Street 2:SUITE D4
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5615
Practice Address - Country:US
Practice Address - Phone:831-637-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD33131223G0001X
CA650711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice