Provider Demographics
NPI:1255339206
Name:SEABERG, K. ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:K.
Middle Name:ROBERT
Last Name:SEABERG
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 1:602 N WINFREE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2310
Mailing Address - Country:US
Mailing Address - Phone:936-258-5597
Mailing Address - Fax:936-258-5596
Practice Address - Street 1:602 N WINFREE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2310
Practice Address - Country:US
Practice Address - Phone:936-258-5597
Practice Address - Fax:936-258-5596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TX95471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice