Provider Demographics
NPI:1427060813
Name:TIMMIS, DAVID P (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:TIMMIS
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 1:122 STONINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1349
Mailing Address - Country:US
Mailing Address - Phone:770-486-8039
Mailing Address - Fax:
Practice Address - Street 1:402 STEVENS ENTRY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4050
Practice Address - Country:US
Practice Address - Phone:770-487-3807
Practice Address - Fax:770-487-1259
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19NCBRJMedicare ID - Type Unspecified
GAT97874Medicare UPIN