Provider Demographics
NPI:1316494537
Name:DR. TIMOTHY L SWEATMAN DDS PS
Entity type:Organization
Organization Name:DR. TIMOTHY L SWEATMAN DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-468-7744
Mailing Address - Street 1:775 E HOLLAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-5016
Mailing Address - Country:US
Mailing Address - Phone:509-468-7744
Mailing Address - Fax:509-468-7544
Practice Address - Street 1:775 E HOLLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-5016
Practice Address - Country:US
Practice Address - Phone:509-468-7744
Practice Address - Fax:509-468-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000079021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00007902OtherDENTIST