Provider Demographics
NPI:1619351400
Name:SEALE FAMILY DENTAL PC
Entity Type:Organization
Organization Name:SEALE FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-566-1980
Mailing Address - Street 1:205 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1228
Mailing Address - Country:US
Mailing Address - Phone:256-566-1980
Mailing Address - Fax:
Practice Address - Street 1:1209 6TH ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-2146
Practice Address - Country:US
Practice Address - Phone:205-699-2731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6025261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental