Provider Demographics
NPI:1881180560
Name:SEUBERT, PARKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARKER
Middle Name:
Last Name:SEUBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 S MARTIN ST APT A315
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6132
Mailing Address - Country:US
Mailing Address - Phone:920-312-0777
Mailing Address - Fax:
Practice Address - Street 1:1234 S HOVER ST STE 100
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7962
Practice Address - Country:US
Practice Address - Phone:720-907-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist