Provider Demographics
NPI:1114319845
Name:TEA, KASEY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:WILLIAM
Last Name:TEA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 30TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9407
Mailing Address - Country:US
Mailing Address - Phone:505-327-9161
Mailing Address - Fax:505-326-6657
Practice Address - Street 1:RHEINLAND-PFALZ DHA
Practice Address - Street 2:CMR 402 UNIT 33301
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:314-590-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203017122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist