Provider Demographics
NPI:1184786881
Name:NIBERT, TIMOTHY LEWIS (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEWIS
Last Name:NIBERT
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 1:5040 PALMETTO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1718
Mailing Address - Country:US
Mailing Address - Phone:614-878-7733
Mailing Address - Fax:614-870-2510
Practice Address - Street 1:5040 PALMETTO ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1718
Practice Address - Country:US
Practice Address - Phone:614-878-7733
Practice Address - Fax:614-870-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-8394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist