Healthcare Provider Details

I. General information

NPI: 1114102357
Provider Name (Legal Business Name): TIMOTHY W. GIFFORD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5595 WINFIELD BLVD STE 208
SAN JOSE CA
95123-1220
US

IV. Provider business mailing address

5595 WINFIELD BLVD STE 208
SAN JOSE CA
95123-1220
US

V. Phone/Fax

Practice location:
  • Phone: 408-578-6400
  • Fax: 408-578-0641
Mailing address:
  • Phone: 408-578-6400
  • Fax: 408-578-0641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number50059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: