Provider Demographics
NPI:1144211954
Name:TIMOTHS S GULDEMOND DDS
Entity Type:Organization
Organization Name:TIMOTHS S GULDEMOND DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GULDEMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-462-5410
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX06145GUOtherBCBS