Provider Demographics
NPI:1568456994
Name:DUDZINSKI, DAVID J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:DUDZINSKI
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 1:1450 SAM DAVIS ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SMYMA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-459-6974
Mailing Address - Fax:615-459-8806
Practice Address - Street 1:1450 SAM DAVIS ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:SMYMA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-459-6974
Practice Address - Fax:615-459-8806
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBS 81171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440265Medicaid