Provider Demographics
NPI:1629142179
Name:SEELY, KRISTEN KAE
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:KAE
Last Name:SEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 PRESTON FOREST SQ
Mailing Address - Street 2:STE. 264
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2746
Mailing Address - Country:US
Mailing Address - Phone:972-233-2686
Mailing Address - Fax:972-233-8097
Practice Address - Street 1:1450 PRESTON FOREST SQ
Practice Address - Street 2:STE. 264
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2746
Practice Address - Country:US
Practice Address - Phone:972-233-2686
Practice Address - Fax:972-233-8097
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice