Provider Demographics
NPI:1033243985
Name:FEDDOCK, TODD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
Last Name:FEDDOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 LITITZ PIKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6516
Mailing Address - Country:US
Mailing Address - Phone:717-569-8282
Mailing Address - Fax:717-569-8560
Practice Address - Street 1:1887 LITITZ PIKE
Practice Address - Street 2:SUITE 4
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6516
Practice Address - Country:US
Practice Address - Phone:717-569-8282
Practice Address - Fax:717-569-8560
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030400L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice