Provider Demographics
NPI:1194850875
Name:ACORD, TIMOTHY SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:ACORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6520 GLENRIDGE PARK PL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3455
Mailing Address - Country:US
Mailing Address - Phone:502-423-7822
Mailing Address - Fax:502-423-7830
Practice Address - Street 1:6520 GLENRIDGE PARK PL
Practice Address - Street 2:SUITE 7
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3455
Practice Address - Country:US
Practice Address - Phone:502-423-7822
Practice Address - Fax:502-423-7830
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY85881223S0112X, 204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000597508OtherBLUE CROSS BLUE SHIELD
KY7100065320Medicaid
KY0903003Medicare PIN