Healthcare Provider Details

I. General information

NPI: 1558404566
Provider Name (Legal Business Name): TIMOTHY JON O'CONNOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOM BELL RD
MURPHYS CA
95247
US

IV. Provider business mailing address

PO BOX 870
MURPHYS CA
95247-0870
US

V. Phone/Fax

Practice location:
  • Phone: 209-728-3305
  • Fax: 209-728-2957
Mailing address:
  • Phone: 209-728-3305
  • Fax: 209-728-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: