Provider Demographics
NPI:1720381551
Name:TIMOCK, ADAM MCCARTHY (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MCCARTHY
Last Name:TIMOCK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N MACK ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2416
Mailing Address - Country:US
Mailing Address - Phone:913-568-1275
Mailing Address - Fax:
Practice Address - Street 1:3600 MITCHELL DR
Practice Address - Street 2:SUITE 40
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5919
Practice Address - Country:US
Practice Address - Phone:970-224-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02786575Medicaid