MEDICARE: DR. STEPHEN CHASE TIMMONS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9190	SC

General Provider Information

NPI Number	:	1598255416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN CHASE TIMMONS DMD

Provider Business Mailing Address
First Line	:	424 S OAKLEY LN
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-5330
Country	:	US
Telephone Number	:	864-576-8861
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 OLD FURNACE RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316
Country	:	US
Telephone Number	:	864-578-8344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	07/05/2018

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