Provider Demographics
NPI:1770540866
Name:ICENHOWER, TIMOTHY JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAY
Last Name:ICENHOWER
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 18TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5902
Mailing Address - Country:US
Mailing Address - Phone:972-379-3359
Mailing Address - Fax:972-767-3289
Practice Address - Street 1:1000 18TH ST STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5902
Practice Address - Country:US
Practice Address - Phone:972-379-3359
Practice Address - Fax:972-767-3289
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist