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General NPI Number Information
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NPI Number | 1659803112
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Entity Type | Organization
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Legal Business Name | ADUDDELL DENTISTRY PLLC
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1300 MEDICAL AVE STE 101
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City | PLANO
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State | TX
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Zip | 75075-7798
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Country | US
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Telephone | 972-985-4765
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 MEDICAL AVE STE 101
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City | PLANO
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State | TX
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Zip | 75075-7798
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KEVIN ADUDDELL
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Credential |
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Telephone | 972-985-4765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D28976
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License Number State | TX
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