Provider Demographics
NPI:1104087675
Name:KALTALER, TIMOTHY B (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:KALTALER
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 1:7453 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3957
Mailing Address - Country:US
Mailing Address - Phone:315-430-8428
Mailing Address - Fax:
Practice Address - Street 1:7770 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8600
Practice Address - Country:US
Practice Address - Phone:315-458-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9443122300000X
NY053905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist