Provider Demographics
NPI:1649855214
Name:KEVIN B SEDDENS DDSPLLC
Entity type:Organization
Organization Name:KEVIN B SEDDENS DDSPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDDENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-330-7350
Mailing Address - Street 1:1401 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-6331
Mailing Address - Country:US
Mailing Address - Phone:870-330-7350
Mailing Address - Fax:870-330-7347
Practice Address - Street 1:1401 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6331
Practice Address - Country:US
Practice Address - Phone:870-330-7350
Practice Address - Fax:870-330-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental