Provider Demographics
NPI:1134265952
Name:KELLAR, PATRICIA NOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:NOEL
Last Name:KELLAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5463
Mailing Address - Country:US
Mailing Address - Phone:972-612-9737
Mailing Address - Fax:972-612-8647
Practice Address - Street 1:5509 PLEASANT VALLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5248
Practice Address - Country:US
Practice Address - Phone:972-612-9737
Practice Address - Fax:972-612-8647
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice