Provider Demographics
NPI:1952496879
Name:DOUGLAS A SEYMOUR, DDS, PS
Entity Type:Organization
Organization Name:DOUGLAS A SEYMOUR, DDS, PS
Other - Org Name:OAK TREE FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-363-4300
Mailing Address - Street 1:10004 AURORA AVE N
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9349
Mailing Address - Country:US
Mailing Address - Phone:206-363-4300
Mailing Address - Fax:206-985-3862
Practice Address - Street 1:10004 AURORA AVE N
Practice Address - Street 2:SUITE 14
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9349
Practice Address - Country:US
Practice Address - Phone:206-363-4300
Practice Address - Fax:206-985-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6613OtherDENTAL LICENSE
WA10218OtherDENTAL LICENSE
WA9383OtherDENTAL LICENSE