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General NPI Number Information
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NPI Number | 1447544754
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Entity Type | Organization
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Legal Business Name | TIMOTHY B.DOTSON D.D.S., PC
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 2155 W ROSCOE ST STE 1N
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City | CHICAGO
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State | IL
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Zip | 60618-6261
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Country | US
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Telephone | 773-528-3384
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Fax | 773-528-3604
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Provider Business Mailing Address
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Address Line | 2155 WEST ROSCOE STREET, 1N
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City | CHICAGO
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State | IL
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Zip | 60618
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Country | US
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Telephone | 773-528-3384
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Fax | 773-528-3604
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. TIMOTHY B. DOTSON
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Credential | D.D.S.
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Telephone | 773-528-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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