Healthcare Provider Details

I. General information

NPI: 1801105556
Provider Name (Legal Business Name): TIMBERLAND DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 1ST ST
BAY MINETTE AL
36507-4029
US

IV. Provider business mailing address

301 E 1ST ST
BAY MINETTE AL
36507-4029
US

V. Phone/Fax

Practice location:
  • Phone: 251-580-0979
  • Fax: 251-580-0971
Mailing address:
  • Phone: 251-580-0979
  • Fax: 251-580-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5114
License Number StateAL

VIII. Authorized Official

Name: DR. HARRY HUGER HOUSTON III
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 251-580-0979