Provider Demographics
NPI:1386618395
Name:ATKINSON, TIMOTHY J (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:ATKINSON
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 1:1201 N CHURCH ST # A
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1453
Mailing Address - Country:US
Mailing Address - Phone:570-455-2227
Mailing Address - Fax:570-455-0227
Practice Address - Street 1:1201 N CHURCH ST # A
Practice Address - Street 2:SUITE 110
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1453
Practice Address - Country:US
Practice Address - Phone:570-455-2227
Practice Address - Fax:570-455-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023943L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001135703Medicaid
PA001135703Medicaid
T25340Medicare UPIN