Provence, Timothy D

Provence, Timothy D is an individual health care provider with primary practice located at 207 23Rd Ave N , Nashville TN 37203-1501. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Provence, Timothy D can be contacted via phone (615) 320-1392.

Contact Information

Primary practice address
207 23Rd Ave N Nashville TN 37203-1501
Phone: (615) 320-1392
Fax: (615) 329-4245
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X Tennessee

Profile Details

NPI number 1982601829
LBN Legal business name Provence, Timothy D
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982601829 NPPES
Tennessee MEDICAID 3225637

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