Provider Demographics
NPI:1053525642
Name:JASON TIMMONS, DDS, PA
Entity type:Organization
Organization Name:JASON TIMMONS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-535-5616
Mailing Address - Street 1:4301 S MULBERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7005
Mailing Address - Country:US
Mailing Address - Phone:870-535-5616
Mailing Address - Fax:870-535-5628
Practice Address - Street 1:4301 S MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7005
Practice Address - Country:US
Practice Address - Phone:870-535-5616
Practice Address - Fax:870-535-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty