MEDICARE: DR TIMOTHY FERRE 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	1223G0001X	General Practice Dentistry	1617C	UT

General Provider Information

NPI Number	:	1982812020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR TIMOTHY FERRE DDS

Provider Business Mailing Address
First Line	:	3690 E FORT UNION BLVD
Second Line	:	# 203
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121
Country	:	US
Telephone Number	:	801-942-2324
Fax Number	:	801-942-0745

Provider Business Practice Location Address
First Line	:	3690 E FORT UNION BLVD
Second Line	:	# 203
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121
Country	:	US
Telephone Number	:	801-942-2324
Fax Number	:	801-942-0745

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. TIMOTHY JESS FERRE
Credential	:	DDS
Telephone Number	:	801-942-2324

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/09/2007

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