Provider Demographics
NPI:1447414248
Name:SEASHOLTZ, IRA JOHN II (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:JOHN
Last Name:SEASHOLTZ
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6753 THOMASVILLE RD
Mailing Address - Street 2:SUITE 108, PMB 224
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3966
Mailing Address - Country:US
Mailing Address - Phone:850-877-3022
Mailing Address - Fax:850-877-4941
Practice Address - Street 1:2003 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5307
Practice Address - Country:US
Practice Address - Phone:850-877-3022
Practice Address - Fax:850-877-4941
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist