Provider Demographics
NPI:1629268008
Name:SEABERG, PHILIP W (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
Last Name:SEABERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 F ST SW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1366
Mailing Address - Country:US
Mailing Address - Phone:509-787-4531
Mailing Address - Fax:509-787-0809
Practice Address - Street 1:520 F ST SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1366
Practice Address - Country:US
Practice Address - Phone:509-787-4531
Practice Address - Fax:509-787-0809
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist