MEDICARE: SEALE TX4 INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1114673019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEALE TX4 INC.

Provider Business Mailing Address
First Line	:	2627 CALDER ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 HIGHWAY 365 STE F
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7719
Country	:	US
Telephone Number	:	409-721-6300
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	JOHN J. SEALE
Credential	:	DDS, FAGD
Telephone Number	:	409-679-2518

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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