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General NPI Number Information
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NPI Number | 1336675784
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Entity Type | Organization
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Legal Business Name | OWEN AND TIMOCK ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 3221 EASTBROOK DR BUILDING A SUITE 103
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City | FORT COLLINS
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State | CO
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Zip | 80525-5708
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Country | US
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Telephone | 970-484-4102
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Fax | 970-484-1591
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Provider Business Mailing Address
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Address Line | 3221 EASTBROOK DR BUILDING A SUITE 103
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City | FORT COLLINS
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State | CO
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Zip | 80525-5708
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Country | US
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Telephone | 970-484-4102
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Fax | 970-484-1591
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADAM M TIMOCK
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Credential | DDS, MS
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Telephone | 913-568-1275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9259
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10298
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License Number State | CO
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