Basic Information
Provider Information
NPI: 1306026679
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: TIMOTHY
MiddleName: CID
NamePrefix: DR.
NameSuffix:  
Credential: D.M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 59 DAMONTE RANCH PKWY STE F
Address2:  
City: RENO
State: NV
PostalCode: 895212989
CountryCode: US
TelephoneNumber: 7758512204
FaxNumber:  
Practice Location
Address1: 59 DAMONTE RANCH PKWY STE F
Address2:  
City: RENO
State: NV
PostalCode: 895212989
CountryCode: US
TelephoneNumber: 7758512204
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/05/2007
LastUpdateDate: 04/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X56428CAN Dental ProvidersDentist 
1223E0200XS7-88CNVY Dental ProvidersDentistEndodontics

No ID Information.


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