Individual
TIMOTHY DAVID PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1800 FORTINO BLVD UNIT 1, PUEBLO, CO 81008-1891
(719) 545-1400
Mailing address
2554 S KRAMERIA ST, DENVER, CO 80222-7139
(720) 434-0757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN.00205534
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/14/2022
Last updated
07/07/2023
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