MEDICARE: DR. TIMOTHY GEORGE COUGHLIN D.D.S.

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	122300000X	Dentist	DS-021772-L	PA

General Provider Information

NPI Number	:	1114077088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY GEORGE COUGHLIN D.D.S.

Provider Business Mailing Address
First Line	:	1425 N GEORGE ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-2014
Country	:	US
Telephone Number	:	717-848-1693
Fax Number	:	717-848-1698

Provider Business Practice Location Address
First Line	:	1425 N GEORGE ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-2014
Country	:	US
Telephone Number	:	717-848-1693
Fax Number	:	717-848-1698

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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