Healthcare Provider Details

I. General information

NPI: 1265425987
Provider Name (Legal Business Name): STEVEN W. SEIBERT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEVEN W SEIBERT D.M.D., LTD D.M.D.

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 CROSSING CT
CHAMPAIGN IL
61822-6135
US

IV. Provider business mailing address

1804 BENTBROOK DR
CHAMPAIGN IL
61822-9218
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-4867
  • Fax:
Mailing address:
  • Phone: 217-352-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021001261
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: