=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871679092
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY STEVEN HELTON DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2220 WISTERIA DR SUITE 300
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-836-2107
-----------------------------------------------------
Fax | 770-978-5157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2326 LAKE RIDGE TERRACE
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-822-1431
-----------------------------------------------------
Fax | 770-978-5187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 10726
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------