=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043261175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY WILLIAM BUDAY DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4870 N ADAMS RD C-100
-----------------------------------------------------
City | OAKLAND TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48306-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-754-1111
-----------------------------------------------------
Fax | 248-373-3325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4651 BALDWIN RD
-----------------------------------------------------
City | METAMORA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48455-8928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-678-2033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 014236
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------