Provider Demographics
NPI:1295118040
Name:BOUDREAUX, CHRISTY MINTER (DDS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MINTER
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 1:175 LEE ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7577
Mailing Address - Country:US
Mailing Address - Phone:409-755-6565
Mailing Address - Fax:409-755-3718
Practice Address - Street 1:175 LEE ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7577
Practice Address - Country:US
Practice Address - Phone:409-755-6565
Practice Address - Fax:409-755-3718
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist