Provider Demographics
NPI:1013797851
Name:DRYDALE, TOROS
Entity Type:Individual
Prefix:
First Name:TOROS
Middle Name:
Last Name:DRYDALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3261
Mailing Address - Country:US
Mailing Address - Phone:816-509-7560
Mailing Address - Fax:
Practice Address - Street 1:901 WHALEN RD STE A
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1766
Practice Address - Country:US
Practice Address - Phone:608-467-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician