Provider Demographics
NPI:1639985948
Name:TRAVIS ADUDDELL, DDS PLLC
Entity type:Organization
Organization Name:TRAVIS ADUDDELL, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-703-0361
Mailing Address - Street 1:10670 N CENTRAL EXPY STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1074
Mailing Address - Country:US
Mailing Address - Phone:214-553-8499
Mailing Address - Fax:
Practice Address - Street 1:10670 N CENTRAL EXPY STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1074
Practice Address - Country:US
Practice Address - Phone:214-553-8499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty