Provider Demographics
NPI:1114140902
Name:NETTLES, TIMOTHY DOYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DOYLE
Last Name:NETTLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-0558
Mailing Address - Country:US
Mailing Address - Phone:205-669-6778
Mailing Address - Fax:205-669-6779
Practice Address - Street 1:204 MILDRED ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-0558
Practice Address - Country:US
Practice Address - Phone:205-669-6778
Practice Address - Fax:205-669-6779
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL52481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice