Healthcare Provider Details

I. General information

NPI: 1679627731
Provider Name (Legal Business Name): ROBERT SEITZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SOUTH GOODWIN LANE
LONE PINE CA
93545
US

IV. Provider business mailing address

13412 PHOENIX PALM CT
BAKERSFIELD CA
93314-6663
US

V. Phone/Fax

Practice location:
  • Phone: 760-876-4795
  • Fax: 760-876-5624
Mailing address:
  • Phone: 661-695-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number31997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: