Active NPI
Tim Gough, DDS
- Dentist
- Parkville, MD
National Provider Identifier
1104483791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17197
- Practice address
- 9010 Harford Rd
Parkville, MD 21234-4033 - Phone
- (410) 665-2202
- Fax
- (410) 665-9008
- NPI assigned
- May 20, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17197 | MD | Primary |
Addresses
Primary practice location
9010 Harford Rd
Parkville, MD 21234-4033
Mailing address
2410 Ravenview Rd
Timonium, MD 21093-2716
Phone (410) 252-3526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James G Kokorelis D.D.S. P.a. | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Parkville, MD
- NPI 1982135935
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1104483791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2410 RAVENVIEW RD",
"city": "TIMONIUM",
"state": "MD",
"postal_code": "210932716",
"telephone_number": "410-252-3526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9010 HARFORD RD",
"city": "PARKVILLE",
"state": "MD",
"postal_code": "212344033",
"telephone_number": "410-665-2202",
"fax_number": "410-665-9008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "TIM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-20",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "17197",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parkville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.