Active NPI
Diane Jeanette Dudderar, DDS
- General Practice Dentistry
- Middletown, DE
National Provider Identifier
1902993777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- GI0000963
- Practice address
- 600 N Broad St
Middletown, DE 19709-1032 - Phone
- (302) 376-7882
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | GI0000963 | DE | Primary |
Addresses
Primary practice location
600 N Broad St
Middletown, DE 19709-1032
Mailing address
404 S Broad St
Middletown, DE 19709-1442
Phone (302) 376-9039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150707000895 | DE | Order and Referring Only - Dentist | 6608188586 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GI0000963 | DE | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277337600000",
"number": "1902993777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 S BROAD ST",
"city": "MIDDLETOWN",
"state": "DE",
"postal_code": "197091442",
"telephone_number": "302-376-9039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N BROAD ST",
"city": "MIDDLETOWN",
"state": "DE",
"postal_code": "197091032",
"telephone_number": "302-376-7882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDDERAR",
"first_name": "DIANE",
"middle_name": "JEANETTE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2010-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "DE",
"license": "GI0000963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; 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.