Provider Demographics
NPI:1962816603
Name:ERDLE, TIMOTHY V (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:V
Last Name:ERDLE
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 1:2424 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1522
Mailing Address - Country:US
Mailing Address - Phone:408-482-7023
Mailing Address - Fax:
Practice Address - Street 1:310 TRI STATE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5282
Practice Address - Country:US
Practice Address - Phone:847-662-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0398101223P0300X
IL0190305971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics