MEDICARE: DR. TIMOTHY ANDREW MIXSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0000000	AL

General Provider Information

NPI Number	:	1144069253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ANDREW MIXSON DDS

Provider Business Mailing Address
First Line	:	7612 FRERET ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-5010
Country	:	US
Telephone Number	:	334-728-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	8847 VETERANS MEMORIAL BLVD
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70003-7707
Country	:	US
Telephone Number	:	504-533-8372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	12/15/2025

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