Provider Demographics
NPI:1598396681
Name:SEELI, DIVYA RANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:RANI
Last Name:SEELI
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 1:2679 RIVER PLAZA DR APT 302
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3284
Mailing Address - Country:US
Mailing Address - Phone:201-917-6426
Mailing Address - Fax:
Practice Address - Street 1:3945 MARYSVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3762
Practice Address - Country:US
Practice Address - Phone:916-646-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1047811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice