Provider Demographics
NPI:1801177597
Name:ARCHIDIACONO, ADRIENNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:ARCHIDIACONO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S FM 1187 STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-6452
Mailing Address - Country:US
Mailing Address - Phone:817-406-2025
Mailing Address - Fax:
Practice Address - Street 1:311 S FM 1187 STE 300
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-6452
Practice Address - Country:US
Practice Address - Phone:817-406-2025
Practice Address - Fax:817-406-2055
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry