Provider Demographics
NPI:1811097314
Name:RANDY G SEELY DDS PC
Entity type:Organization
Organization Name:RANDY G SEELY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-436-9121
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty