Provider Demographics
NPI:1679756597
Name:ROBERT L SEYMOUR DDS PA
Entity Type:Organization
Organization Name:ROBERT L SEYMOUR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-377-9065
Mailing Address - Street 1:2711 RANDOLPH RD STE 510
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2027
Mailing Address - Country:US
Mailing Address - Phone:704-377-9065
Mailing Address - Fax:704-377-1437
Practice Address - Street 1:2711 RANDOLPH RD STE 510
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-377-9065
Practice Address - Fax:704-377-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC241437Medicare PIN
NCT 63788Medicare UPIN