MEDICARE: TDN DENTISTRY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1578406781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TDN DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	1212 E BROWARD BLVD STE 200
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2123
Country	:	US
Telephone Number	:	954-654-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 E BROWARD BLVD STE 200
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2123
Country	:	US
Telephone Number	:	954-654-7630
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	TIMOTHY MUSCARO
Credential	:	DDS
Telephone Number	:	813-692-2200

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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