Provider Demographics
NPI:1356346761
Name:ADUDDELL, REBECCA ANN (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:ADUDDELL
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BURNETT TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-1700
Mailing Address - Country:US
Mailing Address - Phone:903-567-2207
Mailing Address - Fax:903-567-1115
Practice Address - Street 1:104 BURNETT TRL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1700
Practice Address - Country:US
Practice Address - Phone:903-567-2207
Practice Address - Fax:903-567-1115
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice