Provider Demographics
NPI:1477128395
Name:LIGHTHOUSE SURGICAL HOLDINGS PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE SURGICAL HOLDINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:713-790-1995
Mailing Address - Street 1:PO BOX 248968
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8968
Mailing Address - Country:US
Mailing Address - Phone:877-667-7669
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 614
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2727
Practice Address - Country:US
Practice Address - Phone:713-790-1995
Practice Address - Fax:713-790-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty