Provider Demographics
NPI:1043469174
Name:TIMIAN, PETER ALBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALBERT
Last Name:TIMIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-1416
Mailing Address - Country:US
Mailing Address - Phone:215-295-8783
Mailing Address - Fax:215-295-2767
Practice Address - Street 1:636 LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1416
Practice Address - Country:US
Practice Address - Phone:215-295-8783
Practice Address - Fax:215-295-2767
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026005L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist