Provider Demographics
NPI:1457354870
Name:CANTY, TIMOTHY CHASE (DDS, MPH, MAGD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHASE
Last Name:CANTY
Suffix:
Gender:M
Credentials:DDS, MPH, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EAST BASSE RD., STE 180
Mailing Address - Street 2:UNIT 522
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:184-774-0290
Mailing Address - Fax:
Practice Address - Street 1:9234 N LOOP 1604 W STE 121&123
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2983
Practice Address - Country:US
Practice Address - Phone:847-740-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-153201223G0001X
OH30.0235851223G0001X
WI1002349-151223G0001X
AKDENT13841223G0001X
TX264301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice