Provider Demographics
NPI:1013981620
Name:VERWEST, TIM M (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:M
Last Name:VERWEST
Suffix:
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:9371 CYPRESS LAKE DR
Mailing Address - Street 2:SUITE7
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4939
Mailing Address - Country:US
Mailing Address - Phone:239-482-2722
Mailing Address - Fax:239-482-7877
Practice Address - Street 1:9371 CYPRESS LAKE DR
Practice Address - Street 2:SUITE7
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4939
Practice Address - Country:US
Practice Address - Phone:239-482-2722
Practice Address - Fax:239-482-7877
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL120891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073699601Medicaid
FL073699600Medicaid