Provider Demographics
NPI:1780104836
Name:GENGEL, TIMOTHY J (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:GENGEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 US HIGHWAY 259 N
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7772
Mailing Address - Country:US
Mailing Address - Phone:903-758-5551
Mailing Address - Fax:903-758-5877
Practice Address - Street 1:3665 US HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7772
Practice Address - Country:US
Practice Address - Phone:903-758-5551
Practice Address - Fax:903-758-5877
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice