Provider Demographics
NPI:1366785602
Name:POYADOU, TIMOTHY MICHAEL JR (BS, DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:POYADOU
Suffix:JR
Gender:M
Credentials:BS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 TYLER SQ STE 4
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3060
Mailing Address - Country:US
Mailing Address - Phone:985-266-2000
Mailing Address - Fax:985-266-2002
Practice Address - Street 1:100 TYLER SQ STE 4
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3060
Practice Address - Country:US
Practice Address - Phone:985-266-2000
Practice Address - Fax:985-266-2002
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19309122300000X, 1223X0400X
LA63771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist