Provider Demographics
NPI:1356367056
Name:VERHAREN, TIMOTHY C (DDS,PLLC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:VERHAREN
Suffix:
Gender:M
Credentials:DDS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 WHEATON WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3371
Mailing Address - Country:US
Mailing Address - Phone:360-373-2539
Mailing Address - Fax:360-373-1721
Practice Address - Street 1:2625 WHEATON WAY
Practice Address - Street 2:SUITE D
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3371
Practice Address - Country:US
Practice Address - Phone:360-373-2539
Practice Address - Fax:360-373-1721
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA201273148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5046560Medicare ID - Type Unspecified