Provider Demographics
NPI:1194985275
Name:TIMKO, TODD TREVOR (DMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:TREVOR
Last Name:TIMKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:SUITE #44A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-474-3854
Mailing Address - Fax:850-476-8290
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:SUITE #44A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-474-3854
Practice Address - Fax:850-476-8290
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018-0015571223S0112X
FLDN 171061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery