Healthcare Provider Details

I. General information

NPI: 1144069253
Provider Name (Legal Business Name): TIMOTHY ANDREW MIXSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8847 VETERANS MEMORIAL BLVD
METAIRIE LA
70003-7707
US

IV. Provider business mailing address

7612 FRERET ST
NEW ORLEANS LA
70118-5010
US

V. Phone/Fax

Practice location:
  • Phone: 504-533-8372
  • Fax:
Mailing address:
  • Phone: 334-728-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0000000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: