Provider Demographics
NPI:1316961543
Name:SMITH, TIMOTHY A (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:SMITH
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 1:609 E MAIN ST
Mailing Address - Street 2:T
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3182
Mailing Address - Country:US
Mailing Address - Phone:540-338-0110
Mailing Address - Fax:540-338-0112
Practice Address - Street 1:609 E MAIN ST
Practice Address - Street 2:T
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3182
Practice Address - Country:US
Practice Address - Phone:540-338-0110
Practice Address - Fax:540-338-0112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA77921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice