Provider Demographics
NPI:1780977736
Name:NEAL TIMON DDS LLC
Entity type:Organization
Organization Name:NEAL TIMON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-696-7031
Mailing Address - Street 1:85-910 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2651
Mailing Address - Country:US
Mailing Address - Phone:808-696-7031
Mailing Address - Fax:808-696-3010
Practice Address - Street 1:85-910 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2651
Practice Address - Country:US
Practice Address - Phone:808-696-7031
Practice Address - Fax:808-696-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI066087-04Medicaid