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General NPI Number Information
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NPI Number | 1114319845
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Entity Type | Individual
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Provider Name | KASEY WILLIAM TEA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | RHEINLAND-PFALZ DHA CMR 402 UNIT 33301
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City | APO
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State | AE
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Zip | 09180
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Country | US
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Telephone | 314-590-7261
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Fax |
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Provider Business Mailing Address
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Address Line | 800 E 30TH ST SUITE 3
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City | FARMINGTON
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State | NM
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Zip | 87401-9407
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Country | US
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Telephone | 505-327-9161
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Fax | 505-326-6657
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00203017
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License Number State | CO
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