Provider Demographics
NPI:1982832929
Name:HOUSE, TIMOTHY BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRYAN
Last Name:HOUSE
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 1:1201 NE 26TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1206
Mailing Address - Country:US
Mailing Address - Phone:954-870-6970
Mailing Address - Fax:954-909-0140
Practice Address - Street 1:1201 NE 26TH ST STE 107
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1206
Practice Address - Country:US
Practice Address - Phone:954-870-6970
Practice Address - Fax:954-909-0140
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist