Provider Demographics
NPI:1023131455
Name:USUDE, TEDDY T (DDS)
Entity type:Individual
Prefix:MR
First Name:TEDDY
Middle Name:T
Last Name:USUDE
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 1:26123 RENE VELUZZAT WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2187
Mailing Address - Country:US
Mailing Address - Phone:661-951-1925
Mailing Address - Fax:661-951-1961
Practice Address - Street 1:830 W AVENUE L
Practice Address - Street 2:129
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7206
Practice Address - Country:US
Practice Address - Phone:661-280-0012
Practice Address - Fax:661-951-1961
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice