Provider Demographics
NPI:1376974816
Name:TIMOTHY J O'SHEA DDS PA
Entity Type:Organization
Organization Name:TIMOTHY J O'SHEA DDS PA
Other - Org Name:O'SHEA & O'SHEA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-373-7818
Mailing Address - Street 1:755 COMMERCE DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2627
Mailing Address - Country:US
Mailing Address - Phone:404-373-7818
Mailing Address - Fax:404-638-5115
Practice Address - Street 1:755 COMMERCE DR
Practice Address - Street 2:520
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2627
Practice Address - Country:US
Practice Address - Phone:404-373-7818
Practice Address - Fax:404-638-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty