Provider Demographics
NPI:1356902357
Name:DUDLEY, EMILEE (DDS)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:DUDLEY
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 1:1028 MORNINGSIDE CT
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2974
Mailing Address - Country:US
Mailing Address - Phone:208-521-8295
Mailing Address - Fax:
Practice Address - Street 1:507 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-8328
Practice Address - Country:US
Practice Address - Phone:903-603-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist