Provider Demographics
NPI:1437465648
Name:IMAFIDON, TIMOTHY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:IMAFIDON
Suffix:JR
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 1:300 S CENTER ST
Mailing Address - Street 2:GOLDSBORO PEDIATRIC DENTISTRY & ORTHODONTICS
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-4807
Mailing Address - Country:US
Mailing Address - Phone:919-947-0800
Mailing Address - Fax:
Practice Address - Street 1:300 S CENTER ST
Practice Address - Street 2:GOLDSBORO PEDIATRIC DENTISTRY & ORTHODONTICS
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4807
Practice Address - Country:US
Practice Address - Phone:919-947-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014135681223P0221X
NC102441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry