Provider Demographics
NPI:1952491201
Name:RORMAN, TIMOTHY P (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:RORMAN
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 1:2960 SAINT ROSE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4447
Mailing Address - Country:US
Mailing Address - Phone:619-804-2814
Mailing Address - Fax:
Practice Address - Street 1:4035 S DURANGO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4161
Practice Address - Country:US
Practice Address - Phone:702-804-8888
Practice Address - Fax:702-804-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3345122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist