MEDICARE: ALEXANDER JAMES DUDLEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN0014565	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518975499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER JAMES DUDLEY DMD

Provider Business Mailing Address
First Line	:	2937 JEFFERSON ST
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446
Country	:	US
Telephone Number	:	850-526-3536
Fax Number	:	850-526-3568

Provider Business Practice Location Address
First Line	:	2937 JEFFERSON ST
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446
Country	:	US
Telephone Number	:	850-526-3536
Fax Number	:	850-526-3568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/09/2020

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