Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 041560 | NY |
NPI | 1053411322 |
---|---|
Provider Name | Dr. Timothy M. Blieden |
First Address | Rochester, NY 14626-2724 |
Second Address | Rochester, NY 14626-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 24/02/2009 |