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General NPI Number Information
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NPI Number | 1144211954
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Entity Type | Organization
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Legal Business Name | TIMOTHS S GULDEMOND DDS
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 143 STATE ST UNIT 1
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City | NEWBURYPORT
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State | MA
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Zip | 01950-6621
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Country | US
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Telephone | 978-462-5410
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Fax | 978-465-7822
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Provider Business Mailing Address
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Address Line | 143 STATE ST UNIT 1
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City | NEWBURYPORT
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State | MA
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Zip | 01950-6621
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Country | US
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Telephone | 978-462-5410
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Fax | 978-465-7822
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | TIMOTHY SCOTT GULDEMOND
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Credential | DDS
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Telephone | 978-462-5410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16820
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License Number State | MA
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