Provider Demographics
NPI:1821225707
Name:TIMM, SHELLI SNIPES (RDH)
Entity Type:Individual
Prefix:MS
First Name:SHELLI
Middle Name:SNIPES
Last Name:TIMM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S BURBERRY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-5430
Mailing Address - Country:US
Mailing Address - Phone:281-806-9977
Mailing Address - Fax:
Practice Address - Street 1:6606 FM 1488 RD
Practice Address - Street 2:STE. 136
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2544
Practice Address - Country:US
Practice Address - Phone:936-273-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14928124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist