Healthcare Provider Details

I. General information

NPI: 1699341990
Provider Name (Legal Business Name): JOSEPH FRANCIS DUDLEK II DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST
MEDFORD MA
02155-4540
US

IV. Provider business mailing address

311 CLIFTON ST
MALDEN MA
02148-2437
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-5545
  • Fax:
Mailing address:
  • Phone: 302-824-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859070
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: