MEDICARE: DR. TIMOTHY JAMES NEUNER 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D12275	MN

General Provider Information

NPI Number	:	1952469553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JAMES NEUNER D.D.S.

Provider Business Mailing Address
First Line	:	614 NW ALLISON LN
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-0601
Country	:	US
Telephone Number	:	202-445-1631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 RINGOLD RD
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4449
Country	:	US
Telephone Number	:	580-442-5223
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	09/29/2010

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