Daniel Samuel Tedder, DDS
Individual provider Active NPI General Practice Dentistry · Troutman, NC
NPI 1376570929 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376570929
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 104816 (NC)
- Practice address
- 124 Wagner St
124 Wagner St.
Troutman, NC 28166-9627 - Phone
- (704) 528-9811
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104816 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modlin & Londry VII DDS PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 104816 | NC | Yes |
Addresses
Primary practice location
124 Wagner St
124 Wagner St.
Troutman, NC 28166-9627
Mailing address
124 Wagner St
P.O. Box 921
Troutman, NC 28166-9627
Phone (704) 528-9811
Other providers in Troutman, NC
- Russell E Smith
- Robert Earl Steljes
- Robert Tennyson Stewart
- Sarah E Sturges
- Susan T. Swanson
- The Ultimate Home Care Solution LLC
- Therahealth Solutions LLC
- Stuart Elliott Tolman
- Lewis John Tondo
- Troutman 1St RX Pharmacy
All providers in Troutman, NC · General Practice Dentistry in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.