Provider Demographics
NPI:1679521926
Name:SEYMOUR, HENRY CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CHARLES
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871514
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1514
Mailing Address - Country:US
Mailing Address - Phone:907-376-3574
Mailing Address - Fax:
Practice Address - Street 1:714 POSTAL SERVICE LOOP
Practice Address - Street 2:#7500
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-5000
Practice Address - Country:US
Practice Address - Phone:907-384-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74181223P0700X
AL35441223P0700X
AK12041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics