Provider Demographics
NPI:1518371822
Name:SEARS, ELYSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:
Last Name:SEARS
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 1:3014 DOLORES PARK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1475
Mailing Address - Country:US
Mailing Address - Phone:318-792-2654
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-4224
Practice Address - Country:US
Practice Address - Phone:979-987-6030
Practice Address - Fax:979-476-2035
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice