Provider Demographics
NPI:1942236526
Name:O'SHEA, TIMOTHY J (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:O'SHEA
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 1:755 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:SUITE 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0080721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice