Provider Demographics
NPI:1801410857
Name:SEALE, WILLIAM COLLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COLLIN
Last Name:SEALE
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 1:1430 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4240
Mailing Address - Country:US
Mailing Address - Phone:337-474-0212
Mailing Address - Fax:
Practice Address - Street 1:1430 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4240
Practice Address - Country:US
Practice Address - Phone:337-474-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7079OtherLOUISIANA BOARD OF DENTISTRY