Healthcare Provider Details

I. General information

NPI: 1215149638
Provider Name (Legal Business Name): TIMMONS ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N BOWMAN RD STE 5
LITTLE ROCK AR
72211-2735
US

IV. Provider business mailing address

315 N BOWMAN RD STE 5
LITTLE ROCK AR
72211-2735
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-3758
  • Fax: 501-223-3750
Mailing address:
  • Phone: 501-223-3758
  • Fax: 501-223-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3430
License Number StateAR

VIII. Authorized Official

Name: DR. JASON ERIC TIMMONS
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 501-223-3758