Provider Demographics
NPI:1154917672
Name:DR. TIMOTHY J. WACHUTA
Entity type:Organization
Organization Name:DR. TIMOTHY J. WACHUTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WACHUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-278-2800
Mailing Address - Street 1:2305 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2372
Mailing Address - Country:US
Mailing Address - Phone:303-278-2800
Mailing Address - Fax:303-278-8448
Practice Address - Street 1:2305 JACKSON ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2372
Practice Address - Country:US
Practice Address - Phone:303-278-2800
Practice Address - Fax:303-278-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental