Healthcare Provider Details

I. General information

NPI: 1932561040
Provider Name (Legal Business Name): SEIBEL SPYROU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BOSTON POST RD SUITE 6
SUDBURY MA
01776-3058
US

IV. Provider business mailing address

410 BOSTON POST RD SUITE 6
SUDBURY MA
01776-3058
US

V. Phone/Fax

Practice location:
  • Phone: 987-443-5431
  • Fax: 987-443-5465
Mailing address:
  • Phone: 987-443-5431
  • Fax: 987-443-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KRISTINE SEIBEL
Title or Position: MANAGER
Credential: DMD
Phone: 987-443-5431