Healthcare Provider Details

I. General information

NPI: 1649635061
Provider Name (Legal Business Name): KRISTINE E SEIBEL DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BOSTON POST RD
SUDBURY MA
01776-3058
US

IV. Provider business mailing address

410 BOSTON POST RD
SUDBURY MA
01776-3058
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-5431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN19515
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1856182
License Number StateMA

VIII. Authorized Official

Name: DR. KRISTINE E SEIBEL
Title or Position: MEMBER
Credential: D.M.D.
Phone: 978-443-5431