Provider Demographics
NPI:1184621351
Name:SEAQUIST, LAURIE (DDS)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SEAQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4024
Mailing Address - Country:US
Mailing Address - Phone:321-984-9890
Mailing Address - Fax:321-242-9393
Practice Address - Street 1:3200 N WICKHAM RD
Practice Address - Street 2:#5
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2321
Practice Address - Country:US
Practice Address - Phone:321-242-3300
Practice Address - Fax:321-242-9393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL129641223G0001X
MD100221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice