Healthcare Provider Details

I. General information

NPI: 1467581702
Provider Name (Legal Business Name): TIMOTHY JAMES TREMONT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 LINCOLN WAY
MCKEESPORT PA
15131-1725
US

IV. Provider business mailing address

1514 LINCOLN WAY
MCKEESPORT PA
15131-1725
US

V. Phone/Fax

Practice location:
  • Phone: 412-678-0130
  • Fax: 412-678-0130
Mailing address:
  • Phone: 412-678-0130
  • Fax: 412-678-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS020425L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: