Provider Demographics
NPI:1184955122
Name:STRAIT, TIMOTHY M (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:STRAIT
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 1:1917 ARGILLITE RD
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1615
Mailing Address - Country:US
Mailing Address - Phone:606-836-2595
Mailing Address - Fax:606-836-7895
Practice Address - Street 1:1917 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1615
Practice Address - Country:US
Practice Address - Phone:606-836-2595
Practice Address - Fax:606-836-7895
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist