Provider Demographics
NPI:1154593242
Name:DR. TIMOTHY J GEARIN JR
Entity type:Organization
Organization Name:DR. TIMOTHY J GEARIN JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEFORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-536-8800
Mailing Address - Street 1:5 MCCARTHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4205
Mailing Address - Country:US
Mailing Address - Phone:413-536-8800
Mailing Address - Fax:
Practice Address - Street 1:5 MCCARTHY AVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4205
Practice Address - Country:US
Practice Address - Phone:413-536-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty