Basic Information
| Provider Information | |||||||||
| NPI: | 1649565342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2859 E FOUNTAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809102312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194420071 | ||||||||
| FaxNumber: | 7194735303 | ||||||||
| Practice Location | |||||||||
| Address1: | 618 CHURCH ST | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157500342 | ||||||||
| FaxNumber: | 6159861705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2011 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN-10459 | CO | N | Dental Providers | Dentist | 1223G0001X | 27673 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.