Healthcare Provider Details

I. General information

NPI: 1023131455
Provider Name (Legal Business Name): TEDDY T USUDE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W AVENUE L 129
LANCASTER CA
93534-7206
US

IV. Provider business mailing address

26123 RENE VELUZZAT WAY
SANTA CLARITA CA
91321-2187
US

V. Phone/Fax

Practice location:
  • Phone: 661-280-0012
  • Fax: 661-951-1961
Mailing address:
  • Phone: 661-951-1925
  • Fax: 661-951-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: