Provider Demographics
NPI:1851902381
Name:CESSNA, KATELYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:
Last Name:CESSNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1904 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3229
Mailing Address - Country:US
Mailing Address - Phone:903-805-1454
Mailing Address - Fax:
Practice Address - Street 1:761 S MACARTHUR BLVD STE 117
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4228
Practice Address - Country:US
Practice Address - Phone:972-393-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice