Healthcare Provider Details

I. General information

NPI: 1649565342
Provider Name (Legal Business Name): TIMOTHY DAVID JENNINGS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CHURCH ST SUITE 520
NASHVILLE TN
37219-2428
US

IV. Provider business mailing address

2859 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-2312
US

V. Phone/Fax

Practice location:
  • Phone: 615-750-0342
  • Fax: 615-986-1705
Mailing address:
  • Phone: 719-442-0071
  • Fax: 719-473-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-10459
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27673
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: