Provider Demographics
NPI:1205250321
Name:POWELL, DAUDRIE-ANN (DDS)
Entity type:Individual
Prefix:
First Name:DAUDRIE-ANN
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 UNIONPORT RD
Mailing Address - Street 2:APT 1D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7853
Mailing Address - Country:US
Mailing Address - Phone:202-702-1054
Mailing Address - Fax:
Practice Address - Street 1:1510 UNIONPORT RD
Practice Address - Street 2:APT 1D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7853
Practice Address - Country:US
Practice Address - Phone:202-702-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50057125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist