MEDICARE: DR. TIMOTHY MICHAEL WAHL D.M.D.

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	1223P0300X	Periodontics	DN9499	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN9499	OTHER	FL	STATE DENTAL LICENSE

General Provider Information

NPI Number	:	1619972668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MICHAEL WAHL D.M.D.

Provider Business Mailing Address
First Line	:	190 S SYKES CREEK PKWY
Second Line	:	STE 2
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3572
Country	:	US
Telephone Number	:	321-459-0154
Fax Number	:	321-459-0739

Provider Business Practice Location Address
First Line	:	190 S SYKES CREEK PKWY
Second Line	:	STE 2
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3572
Country	:	US
Telephone Number	:	321-459-0154
Fax Number	:	321-459-0739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

Similar Medicare Providers

1255463709 — MAHMOUD A EL-TOBGUI M.D.
Practice Location Address:

190 S SYKES CREEK PKWY
MERRITT ISLAND, FL
32952-3572

Practice Phone: 321-455-6353
Practice Fax: 321-455-6361

1043342595 — BREVARD PAIN CARE PA
Practice Location Address:

190 S SYKES CREEK PKWY , SUITE 1
MERRITT ISLAND, FL
32952-3572

Practice Phone: 321-455-6353
Practice Fax: 321-455-6361

1982877221 — ASH DERMATOLOGY & SKIN CANCER CENTER, PA
Practice Location Address:

190 S SYKES CREEK PKWY , SUITE 3
MERRITT ISLAND, FL
32952-3572

Practice Phone: 321-986-9335
Practice Fax: 321-986-9337

1386975415 — RESTORATION MEDICINE LLC
Practice Location Address:

190 S SYKES CREEK PKWY , SUITE #3
MERRITT ISLAND, FL
32952-3572

Practice Phone: 321-305-6254
Practice Fax: 321-305-5972

1952760365 — BREVARD PAIN CARE, PA
Practice Location Address:

190 S SYKES CREEK PKWY , SUITE 1
MERRITT ISLAND, FL
32952-3572

Practice Phone: 321-455-6353
Practice Fax: 321-455-6361

1548733165 — DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA PA
Practice Location Address:

190 S SYKES CREEK PKWY STE 2
MERRITT ISLAND, FL
32952-3572

Practice Phone: 321-452-8334
Practice Fax: 321-452-8335

Directions to “ DR. TIMOTHY MICHAEL WAHL D.M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.