MEDICARE: DR. TIMOTHY NICHOLAS HO D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN17476	FL

General Provider Information

NPI Number	:	1215077169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY NICHOLAS HO D.M.D

Provider Business Mailing Address
First Line	:	11753 SAN ROSARITA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6022
Country	:	US
Telephone Number	:	954-646-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	11350 SOUTHERN HIGHLANDS PKWY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3291
Country	:	US
Telephone Number	:	702-242-0088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	11/29/2010

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