Provider Demographics
NPI:1457693137
Name:TIMOTHY H. SINNER DDS PC
Entity Type:Organization
Organization Name:TIMOTHY H. SINNER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-252-6005
Mailing Address - Street 1:1209 5TH AVE SE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5601
Mailing Address - Country:US
Mailing Address - Phone:701-252-6005
Mailing Address - Fax:701-251-9188
Practice Address - Street 1:1209 5TH AVE SE
Practice Address - Street 2:SUITE 6
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5601
Practice Address - Country:US
Practice Address - Phone:701-252-6005
Practice Address - Fax:701-251-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND16901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40099Medicaid