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NPI Code Detail

MEDICARE: DR. TIMOTHY MARK STRAIGHT DDS

MEDICARE: DR. TIMOTHY MARK STRAIGHT DDS
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
1122300000XDentist2901012718MI

General Provider Information

NPI Number : 1619099066
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY MARK STRAIGHT DDS
Provider Business Mailing Address
First Line : PO BOX 293
Second Line :
City : PORT AUSTIN
State : MI
Zip : 48467-0293
Country : US
Telephone Number : 989-738-5681
Fax Number :
Provider Business Practice Location Address
First Line : 1405 CENTER AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6109
Country : US
Telephone Number : 989-893-4381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2007
Last Update Date : 07/08/2007

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Directions to “ DR. TIMOTHY MARK STRAIGHT DDS” Practice Location

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