MEDICARE: TIMORHY G. CASE

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	1223G0001X	General Practice Dentistry	AC1905427	MO

General Provider Information

NPI Number	:	1902090277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMORHY G. CASE

Provider Business Mailing Address
First Line	:	4300 HOLLY HILLS BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2253
Country	:	US
Telephone Number	:	314-351-5555
Fax Number	:	314-351-5257

Provider Business Practice Location Address
First Line	:	4300 HOLLY HILLS BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2253
Country	:	US
Telephone Number	:	314-351-5555
Fax Number	:	314-351-5257

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. TIMOTHY G CASE
Credential	:	D.M.D.
Telephone Number	:	314-351-5555

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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