MEDICARE: DR. TIMOTHY JAMES CLARE DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19-013573	IL

General Provider Information

NPI Number	:	1043227382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JAMES CLARE DDS, MS

Provider Business Mailing Address
First Line	:	1242 TOWNES CIR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-6741
Country	:	US
Telephone Number	:	630-978-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2262 OGDEN AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7218
Country	:	US
Telephone Number	:	630-820-1610
Fax Number	:	630-820-1241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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