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General NPI Number Information
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NPI Number | 1588836183
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Entity Type | Individual
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Provider Name | KENNETH SEELY HAVARD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 4402 WILLIAMS DR SUITE 106
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City | GEORGETOWN
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State | TX
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Zip | 78628-1341
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Country | US
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Telephone | 512-818-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 619 CROMWELL WAY
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City | LEXINGTON
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State | KY
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Zip | 40503-4143
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Country | US
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Telephone | 512-818-0232
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 23759
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License Number State | TX
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