Provider Demographics
NPI:1164253605
Name:UDAIPAUL, THEODORE THAKESH (DMD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:THAKESH
Last Name:UDAIPAUL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DUNNWOOD GREEN LN APT 213
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1776
Mailing Address - Country:US
Mailing Address - Phone:215-815-1297
Mailing Address - Fax:
Practice Address - Street 1:950 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1924
Practice Address - Country:US
Practice Address - Phone:716-655-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY0646371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program