Timothy Moder, SAC-IT

NPI 1437332319 · on the registry since 2007

Practice

Address: 1507 Tower Ave
# 307
Superior, WI 54880
Phone: (715) 392-9300
Fax: (715) 392-8041
Organisation at this address: Minh Ngoc Ngo
Nbo Dental, Llc
Twin Ports Dental
Amana Mobility Llc
Alexa Connolly Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 14

Registry record

Primary taxonomy: 101YA0400X
101YA0400X
Licence states on file: WI
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2007-12-13

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin