MEDICARE: DR. TIMOTHY B ANGER D.M.D.

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	4923760-9921	UT

General Provider Information

NPI Number	:	1649418617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY B ANGER D.M.D.

Provider Business Mailing Address
First Line	:	1458 HOLLYWOOD AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3704
Country	:	US
Telephone Number	:	801-391-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	1458 HOLLYWOOD AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3704
Country	:	US
Telephone Number	:	801-391-2179
Fax Number	:

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

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	01/29/2009

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