Healthcare Provider Details

I. General information

NPI: 1326489675
Provider Name (Legal Business Name): RAYMOND LEE SEABURG D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 COMMERCE AVE NE STE 300
PRIOR LAKE MN
55372-1503
US

IV. Provider business mailing address

14120 COMMERCE AVE NE STE 300
PRIOR LAKE MN
55372-1503
US

V. Phone/Fax

Practice location:
  • Phone: 763-227-1244
  • Fax:
Mailing address:
  • Phone: 950-209-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: