Provider Demographics
NPI:1750559753
Name:DO, TIMOTHY C (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:T
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1912 MEERA LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3748
Mailing Address - Country:US
Mailing Address - Phone:817-473-1560
Mailing Address - Fax:
Practice Address - Street 1:708 HUNTERS ROW CT STE 102
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4018
Practice Address - Country:US
Practice Address - Phone:817-473-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice