Basic Information
| Provider Information | |||||||||
| NPI: | 1558713842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'SHEA | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | MEDINN C213, SPC 5831 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | MEDINN C213, SPC 5831 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2016 | ||||||||
| LastUpdateDate: | 07/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901021966 | MI | Y | Dental Providers | Dentist |
No ID Information.