Provider Demographics
NPI:1306969159
Name:ADUDDELL, PATRICK L (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:ADUDDELL
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 1:1300 MEDICAL AVE
Mailing Address - Street 2:#101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-867-5544
Mailing Address - Fax:972-867-3691
Practice Address - Street 1:1300 MEDICAL AVE
Practice Address - Street 2:#101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-867-5544
Practice Address - Fax:972-867-3691
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice