Provider Demographics
NPI:1700991908
Name:ROTHWELL, TIMOTHY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:ROTHWELL
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 1:5500 NW EXPRESSWAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5219
Mailing Address - Country:US
Mailing Address - Phone:405-728-7632
Mailing Address - Fax:405-728-2816
Practice Address - Street 1:5500 NW EXPRESSWAY
Practice Address - Street 2:SUITE F
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5219
Practice Address - Country:US
Practice Address - Phone:405-728-7632
Practice Address - Fax:405-728-2816
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice