Provider Demographics
NPI:1992863559
Name:BOOKMYER, KELSEY LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:LEIGH
Last Name:BOOKMYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2100 ROUND ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4010
Mailing Address - Country:US
Mailing Address - Phone:512-733-5311
Mailing Address - Fax:512-733-5022
Practice Address - Street 1:2100 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4010
Practice Address - Country:US
Practice Address - Phone:512-733-5311
Practice Address - Fax:512-733-5022
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry