Provider Demographics
NPI:1881727808
Name:BOUTROS, AUDREY M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:M
Last Name:BOUTROS
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:6750 WEST LOOP S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4103
Mailing Address - Country:US
Mailing Address - Phone:713-218-8338
Mailing Address - Fax:713-218-6888
Practice Address - Street 1:6750 WEST LOOP S
Practice Address - Street 2:SUITE 150
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4103
Practice Address - Country:US
Practice Address - Phone:713-218-8338
Practice Address - Fax:713-218-6888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX192361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics