Provider Demographics
NPI:1306102033
Name:TIMOTHY C CANTY DDS MPH LTD
Entity type:Organization
Organization Name:TIMOTHY C CANTY DDS MPH LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER /DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CHASE
Authorized Official - Last Name:CANTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:847-740-2900
Mailing Address - Street 1:305 E ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1331
Mailing Address - Country:US
Mailing Address - Phone:847-546-2900
Mailing Address - Fax:847-546-2910
Practice Address - Street 1:305 E ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1331
Practice Address - Country:US
Practice Address - Phone:847-546-2900
Practice Address - Fax:847-546-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL681048741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty