Provider Demographics
NPI:1861525552
Name:POSCH, TIMOTHY ROBERT (DDS)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:POSCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2626
Mailing Address - Country:US
Mailing Address - Phone:218-847-8765
Mailing Address - Fax:218-844-5765
Practice Address - Street 1:101 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2626
Practice Address - Country:US
Practice Address - Phone:218-847-8765
Practice Address - Fax:218-844-5765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN99841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice