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NPI Code Detail

MEDICARE: TIMOTHY G DWYER DDS

MEDICARE: TIMOTHY G DWYER DDS
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
11223G0001XGeneral Practice DentistryD4690OR

General Provider Information

NPI Number : 1053532457
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY G DWYER DDS
Provider Business Mailing Address
First Line : 1212 NE 7TH ST
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-1424
Country : US
Telephone Number : 541-479-2748
Fax Number : 541-479-4701
Provider Business Practice Location Address
First Line : 1212 NE 7TH ST
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-1424
Country : US
Telephone Number : 541-479-2748
Fax Number : 541-479-4701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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Directions to “ TIMOTHY G DWYER DDS” Practice Location

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