Provider Demographics
NPI:1255429197
Name:NEEDHAM, TIM ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:ALLEN
Last Name:NEEDHAM
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:PO BOX 240817
Mailing Address - Street 2:
Mailing Address - City:ECLECTIC
Mailing Address - State:AL
Mailing Address - Zip Code:36024-0016
Mailing Address - Country:US
Mailing Address - Phone:334-541-4002
Mailing Address - Fax:334-541-4021
Practice Address - Street 1:585 CLAUD RD
Practice Address - Street 2:
Practice Address - City:ECLECTIC
Practice Address - State:AL
Practice Address - Zip Code:36024-6318
Practice Address - Country:US
Practice Address - Phone:334-541-4002
Practice Address - Fax:334-541-4021
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL79554OtherBLUECROSS BLUESHIELD OF A
AL801429OtherUNITED CONCORDIA