Individual
TIMOTHY J ITEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1 MARION AVE STE 201, MANSFIELD, OH 44903-7905
(419) 522-5437
Mailing address
1 MARION AVE STE 201, MANSFIELD, OH 44903-7905
(419) 522-5437
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
19305
OH
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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