Provider Demographics
NPI:1316140874
Name:TIMOTHY J. SILLS DMD PC
Entity type:Organization
Organization Name:TIMOTHY J. SILLS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-661-5205
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:102 LOCUST
Mailing Address - City:OLD MONROE
Mailing Address - State:MO
Mailing Address - Zip Code:63369-0047
Mailing Address - Country:US
Mailing Address - Phone:636-661-5205
Mailing Address - Fax:
Practice Address - Street 1:102 LOCUST AVENUE
Practice Address - Street 2:
Practice Address - City:OLD MONROE
Practice Address - State:MO
Practice Address - Zip Code:63369-0047
Practice Address - Country:US
Practice Address - Phone:636-661-5205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty