Provider Demographics
NPI:1932627114
Name:SEALY ORTHODONTICS-SEALY PLLC
Entity Type:Organization
Organization Name:SEALY ORTHODONTICS-SEALY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZBORIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-885-4856
Mailing Address - Street 1:2355 HWY 36 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474
Mailing Address - Country:US
Mailing Address - Phone:979-885-4856
Mailing Address - Fax:979-885-6524
Practice Address - Street 1:2355 HWY 36 SOUTH
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474
Practice Address - Country:US
Practice Address - Phone:979-885-4856
Practice Address - Fax:979-885-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty