Provider Demographics
NPI:1457446338
Name:TEDUITS, ERIC ANTHONY (DDS,MS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANTHONY
Last Name:TEDUITS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 CHAPEL VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7420
Mailing Address - Country:US
Mailing Address - Phone:608-288-0543
Mailing Address - Fax:608-288-0626
Practice Address - Street 1:2971 CHAPEL VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7420
Practice Address - Country:US
Practice Address - Phone:608-288-0543
Practice Address - Fax:608-288-0626
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33704700Medicaid