Healthcare Provider Details

I. General information

NPI: 1316091390
Provider Name (Legal Business Name): JASON ERIC TIMMONS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N BOWMAN SUITE 5
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

315 N BOWMAN SUITE 5
LITTLE ROCK AR
72211
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:
Title or Position:
Credential:
Phone: