Healthcare Provider Details

I. General information

NPI: 1518408269
Provider Name (Legal Business Name): SETH THOMAS DAHLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP/SGHC UNIT 6180
APO AE
09604
US

IV. Provider business mailing address

UNIT 6180 BOX 31ST
APO AE
09604-6180
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009773
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2397
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD009773
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: