MEDICARE: DR. SHELLEY LYNN SEIDEL DDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19913	TX

General Provider Information

NPI Number	:	1164648366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY LYNN SEIDEL DDS MD

Provider Business Mailing Address
First Line	:	8800 KATY FWY
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77024-1633
Country	:	US
Telephone Number	:	713-464-2833
Fax Number	:	713-464-7563

Provider Business Practice Location Address
First Line	:	8800 KATY FWY
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77024-1633
Country	:	US
Telephone Number	:	713-464-2833
Fax Number	:	713-464-7563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/18/2008

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