Provider Demographics
NPI:1255540258
Name:TIMMONS, JAMES HENRY (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY
Last Name:TIMMONS
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 1:5408 N JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9376
Mailing Address - Country:US
Mailing Address - Phone:219-879-5580
Mailing Address - Fax:219-879-5582
Practice Address - Street 1:5408 N JOHNSON RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9376
Practice Address - Country:US
Practice Address - Phone:219-879-5580
Practice Address - Fax:219-879-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120086341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice