Provider Demographics
NPI:1952514010
Name:ZNAMIROWSKI, TIM M (DDS)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:M
Last Name:ZNAMIROWSKI
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 1:553 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2635
Mailing Address - Country:US
Mailing Address - Phone:831-425-8001
Mailing Address - Fax:831-425-3563
Practice Address - Street 1:553 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2635
Practice Address - Country:US
Practice Address - Phone:831-425-8001
Practice Address - Fax:831-425-3563
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice