Provider Demographics
NPI:1679599930
Name:MOORE, TIMOTHY CHARLES (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 PARCHMENT DR SE
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2374
Mailing Address - Country:US
Mailing Address - Phone:616-285-9509
Mailing Address - Fax:616-285-8856
Practice Address - Street 1:826 PARCHMENT DR SE
Practice Address - Street 2:SUITE # 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2374
Practice Address - Country:US
Practice Address - Phone:616-285-9509
Practice Address - Fax:616-285-8856
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010101631223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics