Provider Demographics
NPI:1114619327
Name:SEYLLER, SAVANNAH LOREN (DMD)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:LOREN
Last Name:SEYLLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 N PLACITA DE EDUARDO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2729
Mailing Address - Country:US
Mailing Address - Phone:520-979-2421
Mailing Address - Fax:
Practice Address - Street 1:21001 N TATUM BLVD STE 80-1690
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-5233
Practice Address - Country:US
Practice Address - Phone:480-419-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist