Provider Demographics
NPI:1134324783
Name:GULDEMOND, TIMOTHY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:GULDEMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 STATE ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6621
Mailing Address - Country:US
Mailing Address - Phone:978-462-5410
Mailing Address - Fax:978-465-7822
Practice Address - Street 1:143 STATE ST
Practice Address - Street 2:UNIT 1
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-6621
Practice Address - Country:US
Practice Address - Phone:978-462-5410
Practice Address - Fax:978-465-7822
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice