=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366464638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARD TIMMINS D.D.S, M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 12/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 2ND ST
-----------------------------------------------------
City | MONUMENT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80132-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-488-2806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 2ND ST P.O. BOX 1382
-----------------------------------------------------
City | MONUMENT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80132-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-488-2806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 104602
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------