Provider Demographics
NPI:1821186883
Name:CHAD SEABOLD, D.D.S., M.D., P.L.C.
Entity Type:Organization
Organization Name:CHAD SEABOLD, D.D.S., M.D., P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEABOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:269-343-4789
Mailing Address - Street 1:1850 WHITES RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4801
Mailing Address - Country:US
Mailing Address - Phone:269-343-4789
Mailing Address - Fax:269-345-5142
Practice Address - Street 1:1850 WHITES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4801
Practice Address - Country:US
Practice Address - Phone:269-343-4789
Practice Address - Fax:269-345-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088788261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center