Healthcare Provider Details

I. General information

NPI: 1790400406
Provider Name (Legal Business Name): TDN DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 S 6TH AVE
WAUCHULA FL
33873-3207
US

IV. Provider business mailing address

4890 W KENNEDY BLVD STE 920
TAMPA FL
33609-1850
US

V. Phone/Fax

Practice location:
  • Phone: 863-773-9344
  • Fax: 863-773-9350
Mailing address:
  • Phone: 813-692-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY MUSCARO
Title or Position: OWNER
Credential: DDS
Phone: 813-692-2200