Provider Demographics
NPI:1801041611
Name:CHAD R. SEABOLD, DDS, MD, PA ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:CHAD R. SEABOLD, DDS, MD, PA ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:SEABOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:713-981-0000
Mailing Address - Street 1:5959 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-981-0000
Mailing Address - Fax:
Practice Address - Street 1:5959 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 620
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-981-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1442261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical