Provider Demographics
NPI:1053411322
Name:BLIEDEN, TIMOTHY M (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:BLIEDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 RIDGE RD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2724
Mailing Address - Country:US
Mailing Address - Phone:585-225-4600
Mailing Address - Fax:585-225-6671
Practice Address - Street 1:2081 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2724
Practice Address - Country:US
Practice Address - Phone:585-225-4600
Practice Address - Fax:585-225-6671
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0415601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics