Organization Active NPI

Timberlane Family Dentistry

  • General Practice Dentistry
  • Lecanto, FL
National Provider Identifier
1043600604
Registry record updated Feb 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
593246519 Issued in FL
Legal business name
TIMBERLANE FAMILY DENTISTRY
Practice address
1972 N Future Ter
Lecanto, FL 34461-9341
Phone
(352) 746-9111
Fax
(352) 746-7180
NPI assigned
Feb 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Missy Darlene Degolyer
Title
Reception
Phone
(352) 746-9111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 593246519 FL Primary

Addresses

Primary practice location

1972 N Future Ter
Lecanto, FL 34461-9341

Mailing address

1972 N Future Ter
Lecanto, FL 34461-9341
Phone (352) 746-9111

National Provider Directory

National Provider Directory

Locations

1972 N Future Ter
Lecanto, FL 34461
Phone (352) 746-9111

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1043600604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1972 N FUTURE TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344619341",
            "telephone_number": "352-746-9111",
            "fax_number": "352-746-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1972 N FUTURE TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344619341",
            "telephone_number": "352-746-9111",
            "fax_number": "352-746-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBERLANE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "DEGOLYER",
        "authorized_official_first_name": "MISSY",
        "authorized_official_middle_name": "DARLENE",
        "authorized_official_title_or_position": "RECEPTION",
        "authorized_official_telephone_number": "352-746-9111",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "593246519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lecanto, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.