Provider Demographics
NPI:1689165680
Name:STEELE, KELLYE LAUREN SUTHERLAND (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KELLYE
Middle Name:LAUREN SUTHERLAND
Last Name:STEELE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:KELLYE
Other - Middle Name:LAUREN SUTHERLAND
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:10 CEDAR CV
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6710 SPRING STUEBNER RD STE 700
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-5197
Practice Address - Country:US
Practice Address - Phone:281-791-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX383511223X0400X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program