Provider Demographics
NPI:1417208067
Name:TIMOTHY D. VERNY, DDS, INC.
Entity type:Organization
Organization Name:TIMOTHY D. VERNY, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VERNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-973-6428
Mailing Address - Street 1:13935 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7001
Mailing Address - Country:US
Mailing Address - Phone:310-973-6428
Mailing Address - Fax:
Practice Address - Street 1:13935 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7001
Practice Address - Country:US
Practice Address - Phone:310-973-6428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty