Provider Demographics
NPI:1770241127
Name:DUDEEN DDS PLLC
Entity Type:Organization
Organization Name:DUDEEN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULAZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-245-5279
Mailing Address - Street 1:2217 LOU JOHN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3115 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5803
Practice Address - Country:US
Practice Address - Phone:512-640-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28315OtherTEXAS STATE BOARD OF DENTAL EXAMINERS