Provider Demographics
NPI:1568604262
Name:SEEBA, GARETT JAMES (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:GARETT
Middle Name:JAMES
Last Name:SEEBA
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4326
Mailing Address - Country:US
Mailing Address - Phone:281-461-1982
Mailing Address - Fax:281-461-0261
Practice Address - Street 1:595 E MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4326
Practice Address - Country:US
Practice Address - Phone:281-461-1982
Practice Address - Fax:281-461-0261
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285671223S0112X
TXQ3793204E00000X
LA60581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1893331Medicaid