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General NPI Number Information
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NPI Number | 1407075377
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Entity Type | Individual
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Provider Name | TIMOTHY WILLIAM DUDLEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 4030 S MERIDIAN ST SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-3889
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Country | US
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Telephone | 317-786-9501
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Fax | 317-786-9403
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Provider Business Mailing Address
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Address Line | 4030 S MERIDIAN ST SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-3889
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Country | US
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Telephone | 317-786-9501
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Fax | 317-786-9403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12008850A
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License Number State | IN
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