Provider Demographics
NPI:1831196740
Name:VOLA, TIMOTHY LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LYNN
Last Name:VOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 COBB DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3170
Mailing Address - Country:US
Mailing Address - Phone:850-668-3736
Mailing Address - Fax:
Practice Address - Street 1:1562 WELLS RD
Practice Address - Street 2:SUITE 16
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-1726
Practice Address - Country:US
Practice Address - Phone:904-644-0140
Practice Address - Fax:904-644-0143
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0108301223P0221X
FLDN00101851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00415566 AMedicaid
FL0722669 00Medicaid