Provider Demographics
NPI:1417095027
Name:BUDMAN, DEREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:BUDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 SIENNA RANCH RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:832-886-0033
Mailing Address - Fax:
Practice Address - Street 1:9201 SIENNA RANCH RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:832-886-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013048122300000X
TX21383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist