Provider Demographics
NPI:1982944708
Name:CARR, TIMOTHY LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LAWRENCE
Last Name:CARR
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 1:31 STRAWSER RD
Mailing Address - Street 2:PORT TREVORTON
Mailing Address - City:PORT TREVORTON
Mailing Address - State:PA
Mailing Address - Zip Code:17864-9246
Mailing Address - Country:US
Mailing Address - Phone:570-374-2334
Mailing Address - Fax:570-374-6965
Practice Address - Street 1:31 STRAWSER RD
Practice Address - Street 2:PORT TREVORTON
Practice Address - City:PORT TREVORTON
Practice Address - State:PA
Practice Address - Zip Code:17864-9246
Practice Address - Country:US
Practice Address - Phone:570-374-2334
Practice Address - Fax:570-374-6965
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA-DS025240-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice