Active NPI
Dustin Wade Timmerman, DDS
- General Practice Dentistry
- Leland, NC
National Provider Identifier
1689162448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13522
- Practice address
- 1215 W Gate Dr Ste 180
Leland, NC 28451-0437 - Phone
- (910) 663-1223
- NPI assigned
- Apr 27, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13522 | NC | Primary |
Addresses
Primary practice location
1215 W Gate Dr Ste 180
Leland, NC 28451-0437
Mailing address
PO Box 749625
Atlanta, GA 30374-9625
Phone (910) 663-1223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13522 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oral Implants and Reconstructive Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthodontics
- Lewis Center, OH
- NPI 1942331137
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1689162448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 749625",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303749625",
"telephone_number": "910-663-1223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 W GATE DR STE 180",
"city": "LELAND",
"state": "NC",
"postal_code": "284510437",
"telephone_number": "910-663-1223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMMERMAN",
"first_name": "DUSTIN",
"middle_name": "WADE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-27",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "13522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leland, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.