Healthcare Provider Details

I. General information

NPI: 1598885022
Provider Name (Legal Business Name): TIM ALAN GEFFERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 AIRLINE RD
CORPUS CHRISTI TX
78412-3159
US

IV. Provider business mailing address

801 AIRLINE RD
CORPUS CHRISTI TX
78412-3159
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-5533
  • Fax: 361-992-2999
Mailing address:
  • Phone: 361-992-5533
  • Fax: 361-992-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13180
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: