Provider Demographics
NPI:1598759664
Name:DUDDY, TERRENCE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:A
Last Name:DUDDY
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 1:2A MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07827-3043
Mailing Address - Country:US
Mailing Address - Phone:973-293-3404
Mailing Address - Fax:973-293-7123
Practice Address - Street 1:2A MYRTLE DR
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:NJ
Practice Address - Zip Code:07827-3043
Practice Address - Country:US
Practice Address - Phone:973-293-3404
Practice Address - Fax:973-293-7123
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ8462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist