Provider Demographics
NPI:1669480307
Name:BOUDREAUX, DEBORAH N (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:N
Last Name:BOUDREAUX
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 1:3121 BUFFALO SPEEDWAY
Mailing Address - Street 2:#3107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1971
Mailing Address - Country:US
Mailing Address - Phone:713-927-2009
Mailing Address - Fax:
Practice Address - Street 1:3121 BUFFALO SPEEDWAY
Practice Address - Street 2:#3107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:76901
Practice Address - Country:US
Practice Address - Phone:713-927-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice