Healthcare Provider Details

I. General information

NPI: 1871679092
Provider Name (Legal Business Name): TIMOTHY STEVEN HELTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 WISTERIA DR SUITE 300
SNELLVILLE GA
30078-2656
US

IV. Provider business mailing address

2326 LAKE RIDGE TERRACE
LAWRENCEVILLE GA
30043
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2107
  • Fax: 770-978-5157
Mailing address:
  • Phone: 770-822-1431
  • Fax: 770-978-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10726
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: