Timothy William Dudley, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008850A Issued in IN

Practice address

4030 S Meridian St
Suite a
Indianapolis, IN 46217-3889

Phone

(317) 786-9501

Fax

(317) 786-9403

NPI assigned

Apr 25, 2007

Last updated

Apr 9, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239235200000",
    "number": "1407075377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 S MERIDIAN ST",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462173889",
            "telephone_number": "317-786-9501",
            "fax_number": "317-786-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 S MERIDIAN ST",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462173889",
            "telephone_number": "317-786-9501",
            "fax_number": "317-786-9403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "TIMOTHY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2009-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008850A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Dudley, NP
• Anna Dudley
• Areatha Dudley
• Kelly N Dudley
• Rebecca Nicole Dudley, DO
• Marc E. Duerden, MD
• Jessica Tennille Duerksen, CPNP
• Rachel Duerksen
• Melika Duerson
• Taneisha Duerson, CMA(AAMA)

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.