Healthcare Provider Details

I. General information

NPI: 1639733397
Provider Name (Legal Business Name): TIMMONS DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 OLD FURNACE RD
BOILING SPRINGS SC
29316-7427
US

IV. Provider business mailing address

PO BOX 161899
BOILING SPRINGS SC
29316-0032
US

V. Phone/Fax

Practice location:
  • Phone: 864-578-8344
  • Fax: 864-548-9255
Mailing address:
  • Phone: 864-578-8344
  • Fax: 864-578-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN CHASE TIMMONS
Title or Position: OWNER
Credential: DMD
Phone: 864-578-8344