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General NPI Number Information
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NPI Number | 1437464849
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Entity Type | Organization
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Legal Business Name | TIMOTHY J. ITEN, D.D.S., INC.
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 245 STERKEL BLVD SUITE 101
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City | MANSFIELD
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State | OH
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Zip | 44907-1507
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Country | US
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Telephone | 419-522-5437
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Fax | 419-522-1631
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Provider Business Mailing Address
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Address Line | 245 STERKEL BLVD SUITE 101
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City | MANSFIELD
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State | OH
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Zip | 44907-1507
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Country | US
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Telephone | 419-522-5437
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Fax | 419-522-1631
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY JAMES ITEN
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Credential | D.D.S.
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Telephone | 419-522-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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