Healthcare Provider Details

I. General information

NPI: 1356516637
Provider Name (Legal Business Name): BRETT ANTHONY SESHUL D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 08/23/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5142
APO AP
96368
US

IV. Provider business mailing address

52 MDG UNIT 3690
APO AE
09126
US

V. Phone/Fax

Practice location:
  • Phone: 544-630-4584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7888
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number24124
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: