Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 1598 | AZ |
NPI | 1225182090 |
---|---|
Provider Name | Dr. Tim R Avedovech |
First Address | Mesa, AZ 85204-4512 |
Second Address | Phoenix, AZ 85018-5219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 04/11/2011 |