Healthcare Provider Details

I. General information

NPI: 1639536279
Provider Name (Legal Business Name): TRUMAN SEILER IV D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 W FILLMORE ST
PHOENIX AZ
85009-3812
US

IV. Provider business mailing address

2807 E SUNNYSIDE DR
PHOENIX AZ
85028-1228
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6008
  • Fax:
Mailing address:
  • Phone: 602-404-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: