Healthcare Provider Details

I. General information

NPI: 1679375406
Provider Name (Legal Business Name): MATTIE SEAMANS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 6TH ST
CANON CITY CO
81212-3329
US

IV. Provider business mailing address

121 N 6TH ST
CANON CITY CO
81212-3329
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-2301
  • Fax:
Mailing address:
  • Phone: 719-275-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206601
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: