Healthcare Provider Details

I. General information

NPI: 1346534195
Provider Name (Legal Business Name): CHARLES DANIEL SEAWELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W MAIN ST
KASSON MN
55944-1139
US

IV. Provider business mailing address

305 W MAIN ST
KASSON MN
55944-1139
US

V. Phone/Fax

Practice location:
  • Phone: 507-634-6421
  • Fax: 507-634-2461
Mailing address:
  • Phone: 507-634-6421
  • Fax: 507-634-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12948
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: