MEDICARE: DR. PAUL K SEO D.D.S., M.S.

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	1223P0221X	Pediatric Dentistry	DT-1421	HI

General Provider Information

NPI Number	:	1174787139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL K SEO D.D.S., M.S.

Provider Business Mailing Address
First Line	:	98-1254 KAAHUMANU ST STE A5
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3200
Country	:	US
Telephone Number	:	808-486-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	98-1254 KAAHUMANU ST STE A5
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3200
Country	:	US
Telephone Number	:	808-486-8881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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