Provider Demographics
NPI:1063578748
Name:TIMM, ANDREW M (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:TIMM
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 1:375 NE EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4938
Mailing Address - Country:US
Mailing Address - Phone:541-382-1991
Mailing Address - Fax:541-330-9095
Practice Address - Street 1:375 NE EMERSON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4938
Practice Address - Country:US
Practice Address - Phone:541-382-1991
Practice Address - Fax:541-330-9095
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice