Basic Information
| Provider Information | |||||||||
| NPI: | 1598396681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEELI | ||||||||
| FirstName: | DIVYA | ||||||||
| MiddleName: | RANI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2679 RIVER PLAZA DR APT 302 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958333284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019176426 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3945 MARYSVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958383762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166464100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2020 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 104781 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.