Healthcare Provider Details

I. General information

NPI: 1699408922
Provider Name (Legal Business Name): ALEXANDRA ANN TIMMERMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E PARIS AVE SE
GRAND RAPIDS MI
49546-6130
US

IV. Provider business mailing address

15 OTTAWA AVE NW APT 711
GRAND RAPIDS MI
49503-4833
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-5980
  • Fax:
Mailing address:
  • Phone: 517-285-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: