Provider Demographics
NPI:1861946550
Name:J TIMOTHY DOERNER DDA PA
Entity type:Organization
Organization Name:J TIMOTHY DOERNER DDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-791-1099
Mailing Address - Street 1:2763 STATE ROAD 580
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3350
Mailing Address - Country:US
Mailing Address - Phone:727-791-1099
Mailing Address - Fax:
Practice Address - Street 1:2763 STATE ROAD 580
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3350
Practice Address - Country:US
Practice Address - Phone:727-791-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty