Provider Demographics
NPI:1124143193
Name:ZELLMER, TIMOTHY JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:ZELLMER
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:PO BOX 6890
Mailing Address - Street 2:1301 TWELFTH AVENUE SOUTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6890
Mailing Address - Country:US
Mailing Address - Phone:406-216-5273
Mailing Address - Fax:406-216-5274
Practice Address - Street 1:1301 TWELFTH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59406-6890
Practice Address - Country:US
Practice Address - Phone:406-216-5273
Practice Address - Fax:406-216-5274
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2015MT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice