Provider Demographics
NPI:1063084200
Name:TIMPANARO, EDGARDO NICOLAS (DMD)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:NICOLAS
Last Name:TIMPANARO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 W ARROWHEAD CLUBHOUSE DR APT 1074
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8820
Mailing Address - Country:US
Mailing Address - Phone:602-323-6862
Mailing Address - Fax:
Practice Address - Street 1:1979 WEST VALENCIA ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746
Practice Address - Country:US
Practice Address - Phone:520-204-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist