Provider Demographics
NPI:1982812020
Name:DR TIMOTHY FERRE DDS
Entity Type:Organization
Organization Name:DR TIMOTHY FERRE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JESS
Authorized Official - Last Name:FERRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-942-2324
Mailing Address - Street 1:3690 E FORT UNION BLVD
Mailing Address - Street 2:# 203
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-942-2324
Mailing Address - Fax:801-942-0745
Practice Address - Street 1:3690 E FORT UNION BLVD
Practice Address - Street 2:# 203
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-942-2324
Practice Address - Fax:801-942-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1617C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty