Provider Demographics
NPI:1356486997
Name:TIMMONS, SCOTT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:TIMMONS
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 1:13442 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8400
Mailing Address - Country:US
Mailing Address - Phone:218-829-4207
Mailing Address - Fax:651-351-2948
Practice Address - Street 1:13442 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8400
Practice Address - Country:US
Practice Address - Phone:218-829-4207
Practice Address - Fax:218-829-4160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice