Provider Demographics
NPI:1265569909
Name:CLEVELAND, KELLIE KENDRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:KENDRICK
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 FM 407 STE 150
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7216
Mailing Address - Country:US
Mailing Address - Phone:940-455-7004
Mailing Address - Fax:940-455-7064
Practice Address - Street 1:4110 FM 407 STE 150
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:940-455-7004
Practice Address - Fax:940-455-7064
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice