Provider Demographics
NPI:1619045945
Name:STEADMAN, SID KELLY (DDS)
Entity Type:Individual
Prefix:MR
First Name:SID
Middle Name:KELLY
Last Name:STEADMAN
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 1:1901 HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-259-3367
Mailing Address - Fax:512-259-1956
Practice Address - Street 1:1901 HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641
Practice Address - Country:US
Practice Address - Phone:512-259-3365
Practice Address - Fax:512-259-1956
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist