Provider Demographics
NPI:1033209291
Name:JOHNS, TIMOTHY FULTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:FULTON
Last Name:JOHNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FT. SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-694-6471
Mailing Address - Fax:865-694-0636
Practice Address - Street 1:280 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3351
Practice Address - Country:US
Practice Address - Phone:865-694-6471
Practice Address - Fax:865-694-0636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS28961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice