Provider Demographics
NPI:1376779967
Name:RHOADES, SETH (DDS)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:RHOADES
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-0190
Mailing Address - Country:US
Mailing Address - Phone:307-746-4772
Mailing Address - Fax:307-746-2472
Practice Address - Street 1:17 S SENECA AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2816
Practice Address - Country:US
Practice Address - Phone:307-746-4772
Practice Address - Fax:307-746-2472
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6821122300000X
WY1264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY132764000Medicaid
NE47071268402Medicaid
WY131227800Medicaid