Provider Demographics
NPI:1306005632
Name:BRIAN T. SEESE, D.M.D., P.A.
Entity Type:Organization
Organization Name:BRIAN T. SEESE, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SEESE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-663-6571
Mailing Address - Street 1:175 CARRIAGE CLUB DR APT 11-002
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9112
Mailing Address - Country:US
Mailing Address - Phone:704-663-6571
Mailing Address - Fax:
Practice Address - Street 1:610 JETTON ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9318
Practice Address - Country:US
Practice Address - Phone:704-663-6571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7804302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization