# DR. TIMOTHY MARK DURHAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1205972288
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5428 | NE | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 02/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025144400 | — | NE |
| 05 | — | 1956599 | — | IA |
| 01 | — | 4851 | BCBS | NE |