Provider Demographics
NPI:1871889998
Name:TIMOTHY M. STRAIGHT DDS, PC
Entity type:Organization
Organization Name:TIMOTHY M. STRAIGHT DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-269-9716
Mailing Address - Street 1:223 E HURON AVE
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1316
Mailing Address - Country:US
Mailing Address - Phone:989-269-9716
Mailing Address - Fax:
Practice Address - Street 1:223 E HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1316
Practice Address - Country:US
Practice Address - Phone:989-269-9716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty