| Organization Name: | TIMOTHY P BASHFORD DDS PC |
| NPI Number: | 1063702512 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY PATRICK BASHFORD (OWNER) |
| Mailing Address: | 400 Lake Cook Rd Deerfield |
| State: | IL US |
| Postal Code: | 600155607 |
| Phone Number: | 8472569507 |
| Fax Number: | 8472569750 |
| NPI Enumeration Date: | 04/18/2011 |
| NPI Last Update Date: | 04/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 019017695 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |