Provider Demographics
NPI:1942503594
Name:DR. WILLIAM SEASLY DDS
Entity Type:Organization
Organization Name:DR. WILLIAM SEASLY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEASLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-541-3119
Mailing Address - Street 1:6311 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2311
Mailing Address - Country:US
Mailing Address - Phone:630-541-3119
Mailing Address - Fax:630-324-6361
Practice Address - Street 1:6311 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2311
Practice Address - Country:US
Practice Address - Phone:630-541-3119
Practice Address - Fax:630-324-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty