Provider Demographics
NPI:1073860128
Name:SEABORN, STACY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:SEABORN
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 1:1324 - 23RD ST. S
Mailing Address - Street 2:STE 1A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3702
Mailing Address - Country:US
Mailing Address - Phone:701-237-5616
Mailing Address - Fax:701-271-8813
Practice Address - Street 1:1324 - 23RD ST. S
Practice Address - Street 2:STE 1A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3702
Practice Address - Country:US
Practice Address - Phone:701-237-5616
Practice Address - Fax:701-271-8813
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist