Provider Demographics
NPI:1184776254
Name:ONDREJIK, TIMOTHY LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LOUIS
Last Name:ONDREJIK
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 1:205 LUTHER RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2714
Mailing Address - Country:US
Mailing Address - Phone:814-266-4252
Mailing Address - Fax:814-266-2882
Practice Address - Street 1:205 LUTHER RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2714
Practice Address - Country:US
Practice Address - Phone:814-266-4252
Practice Address - Fax:814-266-2882
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027219L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice