Provider Demographics
NPI:1851491351
Name:SEELY, RANDY GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:GENE
Last Name:SEELY
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 1:326 S EDMONDS LN
Mailing Address - Street 2:101
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3580
Mailing Address - Country:US
Mailing Address - Phone:972-436-9121
Mailing Address - Fax:
Practice Address - Street 1:326 S EDMONDS LN
Practice Address - Street 2:101
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3580
Practice Address - Country:US
Practice Address - Phone:972-436-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry