Provider Demographics
NPI:1568779080
Name:SEIJO, GRACIELA (DDS)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:SEIJO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GRACIELA
Other - Middle Name:
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7746 HIGHWAY 6
Mailing Address - Street 2:SUITE T
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4778
Mailing Address - Country:US
Mailing Address - Phone:281-201-4812
Mailing Address - Fax:
Practice Address - Street 1:7746 HIGHWAY 6
Practice Address - Street 2:SUITE T
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4778
Practice Address - Country:US
Practice Address - Phone:281-201-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59698122300000X
TX0026126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216466729Medicaid