Provider Demographics
NPI:1821527029
Name:KEBODEAUX, ADRIENNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:KEBODEAUX
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 1:300 FM 407 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-3683
Mailing Address - Country:US
Mailing Address - Phone:940-276-1750
Mailing Address - Fax:
Practice Address - Street 1:300 FM 407 E
Practice Address - Street 2:SUITE 100
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-3683
Practice Address - Country:US
Practice Address - Phone:940-276-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist