Provider Demographics
NPI:1437615325
Name:PARKE, TIMOTHY (DMD, MBS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:PARKE
Suffix:
Gender:M
Credentials:DMD, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CONDICT DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2408
Mailing Address - Country:US
Mailing Address - Phone:973-600-5563
Mailing Address - Fax:
Practice Address - Street 1:151 COLONY PARK RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-0001
Practice Address - Country:US
Practice Address - Phone:386-675-0088
Practice Address - Fax:844-704-4268
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN294131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery