Individual
DR. ROBERT JOHN TIMOTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
215 S 4TH ST, MONTPELIER, ID 83254-1591
(208) 847-0153
Mailing address
215 S 4TH ST, MONTPELIER, ID 83254-1591
(208) 847-0153
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D-3060
ID
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
145092-9921
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003303600
—
ID
Enumeration date
04/25/2006
Last updated
12/20/2021
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