Healthcare Provider Details

I. General information

NPI: 1053525642
Provider Name (Legal Business Name): JASON TIMMONS, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S MULBERRY ST STE A
PINE BLUFF AR
71603-7005
US

IV. Provider business mailing address

4301 S MULBERRY ST STE A
PINE BLUFF AR
71603-7005
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-5616
  • Fax: 870-535-5628
Mailing address:
  • Phone: 870-535-5616
  • Fax: 870-535-5628

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: 870-535-5616