Provider Demographics
NPI:1669600342
Name:SEAL, KENT M (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:M
Last Name:SEAL
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 1:9853 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3900
Mailing Address - Country:US
Mailing Address - Phone:801-572-4430
Mailing Address - Fax:801-572-5751
Practice Address - Street 1:9853 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3900
Practice Address - Country:US
Practice Address - Phone:801-572-4430
Practice Address - Fax:801-572-5751
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1379171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice