Healthcare Provider Details

I. General information

NPI: 1316089634
Provider Name (Legal Business Name): DAVID E SEAGO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DRIVE SUITE 225
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DRIVE SUITE 225
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-7324
  • Fax: 601-366-0228
Mailing address:
  • Phone: 601-366-7324
  • Fax: 601-366-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number314100
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: