Provider Demographics
NPI:1720274798
Name:DAVID P. TIMMS., D.D.S.,P.C.
Entity Type:Organization
Organization Name:DAVID P. TIMMS., D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOKFAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-487-3807
Mailing Address - Street 1:406 STEVENS ENTRY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4050
Mailing Address - Country:US
Mailing Address - Phone:770-487-3807
Mailing Address - Fax:770-487-1259
Practice Address - Street 1:406 STEVENS ENTRY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4050
Practice Address - Country:US
Practice Address - Phone:770-487-3807
Practice Address - Fax:770-487-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2936Medicare PIN