Healthcare Provider Details

I. General information

NPI: 1740875277
Provider Name (Legal Business Name): DAVID LUKE SEILER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE BLDG 1078
TAMPA FL
33621-5023
US

IV. Provider business mailing address

6120 S RUSSELL ST
TAMPA FL
33611-4751
US

V. Phone/Fax

Practice location:
  • Phone: 636-236-7063
  • Fax:
Mailing address:
  • Phone: 636-236-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number37771
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number37771
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number37771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: