Provider Demographics
NPI:1255536884
Name:DYMEK, TIMOTHY J (DMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DYMEK
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 1:117 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1607
Mailing Address - Country:US
Mailing Address - Phone:978-632-0267
Mailing Address - Fax:978-630-0120
Practice Address - Street 1:117 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1607
Practice Address - Country:US
Practice Address - Phone:978-632-0267
Practice Address - Fax:978-630-0120
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice