Provider Demographics
NPI:1659716132
Name:VINER, TIMOTHY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:VINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3761
Mailing Address - Country:US
Mailing Address - Phone:561-367-9922
Mailing Address - Fax:
Practice Address - Street 1:240 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3761
Practice Address - Country:US
Practice Address - Phone:561-367-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 128071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice