Provider Demographics
NPI:1518497957
Name:MCDANIELL, SELENA WATKINS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:WATKINS
Last Name:MCDANIELL
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 1:106 S TIMBER TOP DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1492
Mailing Address - Country:US
Mailing Address - Phone:570-637-1089
Mailing Address - Fax:
Practice Address - Street 1:9595 SIX PINES DR STE 6260
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1551
Practice Address - Country:US
Practice Address - Phone:281-298-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist