MEDICARE: DR. TERRENCE A DUDDY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8462	NJ

General Provider Information

NPI Number	:	1598759664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRENCE A DUDDY DDS

Provider Business Mailing Address
First Line	:	2A MYRTLE DR
Second Line	:
City	:	MONTAGUE
State	:	NJ
Zip	:	07827-3043
Country	:	US
Telephone Number	:	973-293-3404
Fax Number	:	973-293-7123

Provider Business Practice Location Address
First Line	:	2A MYRTLE DR
Second Line	:
City	:	MONTAGUE
State	:	NJ
Zip	:	07827-3043
Country	:	US
Telephone Number	:	973-293-3404
Fax Number	:	973-293-7123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	12/16/2009

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