Provider Demographics
NPI:1669587242
Name:DAMON, TIMOTHY JON (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JON
Last Name:DAMON
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 1:6 NORTON ST #A
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1024
Mailing Address - Country:US
Mailing Address - Phone:585-624-4260
Mailing Address - Fax:585-624-4269
Practice Address - Street 1:6 NORTON ST #A
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1024
Practice Address - Country:US
Practice Address - Phone:585-624-4260
Practice Address - Fax:585-624-4269
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist