Provider Demographics
NPI:1053590646
Name:TEDALDI, EUGENE MICHAEL SR (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MICHAEL
Last Name:TEDALDI
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:MICHAEL
Other - Last Name:TEDALDI
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506
Mailing Address - Country:US
Mailing Address - Phone:914-234-7462
Mailing Address - Fax:914-763-5544
Practice Address - Street 1:MAIN STREET 26-28 VILLAGE GREEN
Practice Address - Street 2:SUITE 5
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506
Practice Address - Country:US
Practice Address - Phone:914-234-7462
Practice Address - Fax:914-763-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist