Provider Demographics
NPI:1346730843
Name:SEOTA, JOSE SERAFIN (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:SERAFIN
Last Name:SEOTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 NW 79TH AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6555
Mailing Address - Country:US
Mailing Address - Phone:305-305-1556
Mailing Address - Fax:
Practice Address - Street 1:12260 SW 8TH ST STE 226
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1549
Practice Address - Country:US
Practice Address - Phone:305-556-0666
Practice Address - Fax:305-553-0933
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice