Healthcare Provider Details

I. General information

NPI: 1356047377
Provider Name (Legal Business Name): TIMNATH KIDS DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SIGNAL TREE DR # 1100
TIMNATH CO
80547-4908
US

IV. Provider business mailing address

6020 YELLOWTAIL ST
TIMNATH CO
80547-6000
US

V. Phone/Fax

Practice location:
  • Phone: 775-722-3504
  • Fax:
Mailing address:
  • Phone: 775-722-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KATIE FOSTER
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 775-722-3504