Provider Demographics
NPI:1912173782
Name:TIMOTHY C. DENNY, D.D.S., LLC
Entity Type:Organization
Organization Name:TIMOTHY C. DENNY, D.D.S., LLC
Other - Org Name:TIMOTHY C. DENNY, D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-458-2700
Mailing Address - Street 1:16512 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1217
Mailing Address - Country:US
Mailing Address - Phone:636-458-2700
Mailing Address - Fax:
Practice Address - Street 1:16512 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1217
Practice Address - Country:US
Practice Address - Phone:636-458-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO012479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty