Tim Bouquet
Individual provider Active NPI General Practice Dentistry · Rochester, MN
NPI 1508439290 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1508439290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D14638 (MN)
- Practice address
- 1008 12TH St SE
Rochester, MN 55904-5030 - Phone
- (507) 282-6448
- NPI assigned
- Jul 20, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14638 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 12TH Street Dental Office PA | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D14638 | MN | Yes |
Addresses
Primary practice location
1008 12TH St SE
Rochester, MN 55904-5030
Mailing address
1441 Stoppel LN SW
Rochester, MN 55902-1327
Other providers in Rochester, MN
- Chloe Soyoung Bouma
- Emma Caron Bounmixay
- Bernard Joseph Bouquet
- Katherine Ann Bouquet
- Michelle M Bouquet
- William M Bourne
- Sherry Dawn Boutcher
- Jean Boutin
- Sherronda Jean Bowden
- Jacob Douglas Bowdon
All providers in Rochester, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.