Provider Demographics
NPI:1952334971
Name:KNELLER, TIMOTHY DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DENNIS
Last Name:KNELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 E ILIFF AVE STE U
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1267
Mailing Address - Country:US
Mailing Address - Phone:303-696-9364
Mailing Address - Fax:303-696-6282
Practice Address - Street 1:12101 E ILIFF AVE STE U
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1267
Practice Address - Country:US
Practice Address - Phone:303-696-9364
Practice Address - Fax:303-696-6282
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice