Provider Demographics
NPI:1962578252
Name:MEYER, TIMOTHY M (DMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:MEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PARK PL
Mailing Address - Street 2:SUITE300
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1982
Mailing Address - Country:US
Mailing Address - Phone:920-497-8500
Mailing Address - Fax:920-497-3213
Practice Address - Street 1:1551 PARK PL
Practice Address - Street 2:SUITE300
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1982
Practice Address - Country:US
Practice Address - Phone:920-497-8500
Practice Address - Fax:920-497-3213
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice