Timothy Whaley, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

21312 Issued in FL

Practice address

5947 Factory Shops Blvd
Ellenton, FL 34222-4125

Phone

(941) 479-7936

NPI assigned

Jun 18, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• TDN Dentistry, PLLC

  • General Practice Dentistry
  • Ellenton, FL
  • NPI 1548984453
  NPD

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

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1508247206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 S OSPREY AVE",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342368432",
            "telephone_number": "302-448-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5947 FACTORY SHOPS BLVD",
            "city": "ELLENTON",
            "state": "FL",
            "postal_code": "342224125",
            "telephone_number": "941-479-7936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEY",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-18",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 21312",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "21312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508247206",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Vera Rivas, MSN, APRN, FNP-C
• Conseulo Villareal, RPT
• Walgreen Co
• Valerie Walton
• Jonathan S Ware, MD
• Ladena Wright
• Jessica McKelvie Zeller, ARNP

• Dentist in Ellenton, FL
• Providers in Ellenton, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.