Provider Demographics
NPI:1245445154
Name:MOATS, TIMOTHY EDWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWIN
Last Name:MOATS
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 1:656 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4156
Mailing Address - Country:US
Mailing Address - Phone:614-885-6698
Mailing Address - Fax:614-433-7952
Practice Address - Street 1:656 HIGH STREET
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4156
Practice Address - Country:US
Practice Address - Phone:614-885-6698
Practice Address - Fax:614-433-7952
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist