Provider Demographics
NPI:1578613162
Name:SEABOLD, RICHARD D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:SEABOLD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 N. 10TH STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6112
Mailing Address - Country:US
Mailing Address - Phone:269-345-5141
Mailing Address - Fax:269-353-1440
Practice Address - Street 1:1850 WHITES RD
Practice Address - Street 2:SUITE #1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4801
Practice Address - Country:US
Practice Address - Phone:269-345-5141
Practice Address - Fax:269-345-5142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI100281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4038300Medicaid