Provider Demographics
NPI:1528110814
Name:DANIEL G. TIMMS DDS & JEFFREY KOSLOW DMD PA
Entity type:Organization
Organization Name:DANIEL G. TIMMS DDS & JEFFREY KOSLOW DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-845-1200
Mailing Address - Street 1:1104 COOPER STREET
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3012
Mailing Address - Country:US
Mailing Address - Phone:856-845-1200
Mailing Address - Fax:856-384-8308
Practice Address - Street 1:1104 COOPER STREET
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3012
Practice Address - Country:US
Practice Address - Phone:856-845-1200
Practice Address - Fax:856-384-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100131223G0001X
NJ212611223G0001X
NJ126121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty