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General NPI Number Information
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NPI Number | 1982724886
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Entity Type | Individual
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Provider Name | TIMOTHY A WINDHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 1620 FM 646 RD W STE D
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City | DICKINSON
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State | TX
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Zip | 77539-4580
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Country | US
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Telephone | 281-332-0980
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Fax |
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Provider Business Mailing Address
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Address Line | 2034 FANNIN STA S
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City | HOUSTON
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State | TX
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Zip | 77045-4655
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Country | US
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Telephone | 816-617-8618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22439
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28553
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License Number State | TX
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