Provider Demographics
NPI:1063416725
Name:TIMMS, RUSSELL B (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:B
Last Name:TIMMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4005
Mailing Address - Country:US
Mailing Address - Phone:360-423-5580
Mailing Address - Fax:360-423-5596
Practice Address - Street 1:2020 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4005
Practice Address - Country:US
Practice Address - Phone:360-423-5580
Practice Address - Fax:360-423-5596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42671223G0001X
AK10141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice