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General NPI Number Information
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NPI Number | 1508247206
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Entity Type | Individual
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Provider Name | TIMOTHY WHALEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 5947 FACTORY SHOPS BLVD
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City | ELLENTON
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State | FL
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Zip | 34222-4125
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Country | US
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Telephone | 941-479-7936
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 S OSPREY AVE
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City | SARASOTA
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State | FL
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Zip | 34236-8432
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Country | US
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Telephone | 302-448-0336
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 21312
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21312
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License Number State | FL
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