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General NPI Number Information
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NPI Number | 1437615325
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Entity Type | Individual
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Provider Name | TIMOTHY PARKE DMD, MBS
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Gender | Male
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 151 COLONY PARK RD
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-0001
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Country | US
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Telephone | 386-675-0088
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Fax | 844-704-4268
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Provider Business Mailing Address
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Address Line | 311 CONDICT DR
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-2408
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Country | US
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Telephone | 973-600-5563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN29413
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License Number State | FL
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