Provider Demographics
NPI:1306195425
Name:CASE, TIMOTHY JAMES (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:CASE
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 1:1777 N. BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4020
Mailing Address - Country:US
Mailing Address - Phone:562-597-7260
Mailing Address - Fax:
Practice Address - Street 1:1777 N. BELLFLOWER BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4020
Practice Address - Country:US
Practice Address - Phone:562-597-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist