Provider Demographics
NPI:1952709677
Name:STANFORD, TIMOTHY REX (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:REX
Last Name:STANFORD
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 1:154 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1204
Mailing Address - Country:US
Mailing Address - Phone:585-492-1567
Mailing Address - Fax:585-496-7492
Practice Address - Street 1:154 NORTH ST
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1204
Practice Address - Country:US
Practice Address - Phone:585-492-1567
Practice Address - Fax:585-496-7492
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist