MEDICARE: DR. TIMOTHY DAVID JENNINGS 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
1	122300000X	Dentist	DEN-10459	CO
2	1223G0001X	General Practice Dentistry	27673	TX

General Provider Information

NPI Number	:	1649565342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY DAVID JENNINGS DDS

Provider Business Mailing Address
First Line	:	2859 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2312
Country	:	US
Telephone Number	:	719-442-0071
Fax Number	:	719-473-5303

Provider Business Practice Location Address
First Line	:	618 CHURCH ST
Second Line	:	SUITE 520
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2428
Country	:	US
Telephone Number	:	615-750-0342
Fax Number	:	615-986-1705

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

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	07/01/2021

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