MEDICARE: DR. TIMOTHY D. SINES, INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1063186070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. TIMOTHY D. SINES, INC

Provider Business Mailing Address
First Line	:	1193 PINEVIEW DR STE A
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3395
Country	:	US
Telephone Number	:	304-599-8250
Fax Number	:	304-599-6684

Provider Business Practice Location Address
First Line	:	1193 PINEVIEW DR STE A
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3395
Country	:	US
Telephone Number	:	304-599-8250
Fax Number	:	304-599-6684

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY SINES
Credential	:	DDS
Telephone Number	:	304-599-8250

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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