Provider Demographics
NPI:1578863510
Name:TIMOTHY B. NAOMI, D.D.S., P.A.
Entity type:Organization
Organization Name:TIMOTHY B. NAOMI, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BURNETTE
Authorized Official - Last Name:NAOMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-255-1500
Mailing Address - Street 1:10010 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8494
Mailing Address - Country:US
Mailing Address - Phone:919-255-1500
Mailing Address - Fax:919-863-0808
Practice Address - Street 1:10010 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8494
Practice Address - Country:US
Practice Address - Phone:919-255-1500
Practice Address - Fax:919-863-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty