Provider Demographics
NPI:1528153798
Name:CARRION, TIMOTHY J (DDS)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:CARRION
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 1:1232 RACE RD
Mailing Address - Street 2:STE 302
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2382
Mailing Address - Country:US
Mailing Address - Phone:410-391-8301
Mailing Address - Fax:410-687-5110
Practice Address - Street 1:1232 RACE RD
Practice Address - Street 2:STE 302
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-391-8301
Practice Address - Fax:410-687-5110
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70861223S0112X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T59484Medicare UPIN
MDV334Medicare ID - Type Unspecified