Provider Demographics
NPI:1235492190
Name:SMITH, TIMOTHY W (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:SMITH
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 1:655 AL HIGHWAY 69 S
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077-3405
Mailing Address - Country:US
Mailing Address - Phone:256-287-1250
Mailing Address - Fax:256-287-1253
Practice Address - Street 1:655 AL HIGHWAY 69 S
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077-3405
Practice Address - Country:US
Practice Address - Phone:256-287-1250
Practice Address - Fax:256-287-1253
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5917 C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist