Provider Demographics
NPI:1053847400
Name:SEA DENTAL PLLC
Entity Type:Organization
Organization Name:SEA DENTAL PLLC
Other - Org Name:DYNAMIC DENTAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUE
Authorized Official - Middle Name:HWAN
Authorized Official - Last Name:SEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-412-0365
Mailing Address - Street 1:1410 CEDAR BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-2932
Mailing Address - Country:US
Mailing Address - Phone:281-837-9090
Mailing Address - Fax:281-837-9050
Practice Address - Street 1:1410 CEDAR BAYOU RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-2932
Practice Address - Country:US
Practice Address - Phone:281-837-9090
Practice Address - Fax:281-837-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30817261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental