Individual
MR. A TIMOTHY DECONINCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11300 E 13 MILE RD, WARREN, MI 48093
(586) 573-6860
(586) 573-6308
Mailing address
11300 E 13 MILE RD, WARREN, MI 48093
(586) 573-6860
(586) 573-6308
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
2901009162
MI
Other
Enumeration date
02/21/2007
Last updated
07/08/2007
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