Provider Demographics
NPI:1689675035
Name:TIMBERLINE FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:TIMBERLINE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:UNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-875-1130
Mailing Address - Street 1:125 INVERNESS DRIVE EAST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:720-875-1130
Mailing Address - Fax:
Practice Address - Street 1:125 INVERNESS DRIVE EAST
Practice Address - Street 2:SUITE 360
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:720-875-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73061223G0001X
CO72851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty