Provider Demographics
NPI:1124383195
Name:THIBODEAUX, TAMMIE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:M
Last Name:THIBODEAUX
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 1:11501 NORTH SAM HOUSTON PARKWAY EAST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396
Mailing Address - Country:US
Mailing Address - Phone:281-454-2000
Mailing Address - Fax:281-454-2002
Practice Address - Street 1:11501 NORTH SAM HOUSTON PARKWAY EAST
Practice Address - Street 2:SUITE C
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396
Practice Address - Country:US
Practice Address - Phone:281-454-2000
Practice Address - Fax:281-454-2002
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice