Individual
REBECCA THIMOTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3099 CENTRAL AVE, LAKE STATION, IN 46405-2207
(219) 763-8112
(219) 962-1189
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013058A
IN
Other
Enumeration date
12/24/2017
Last updated
09/18/2018
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