Provider Demographics
NPI:1730679358
Name:SEALE, ERIN MOORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MOORE
Last Name:SEALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1430 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4240
Mailing Address - Country:US
Mailing Address - Phone:337-474-0212
Mailing Address - Fax:
Practice Address - Street 1:1430 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4240
Practice Address - Country:US
Practice Address - Phone:337-377-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice