Healthcare Provider Details

I. General information

NPI: 1679756597
Provider Name (Legal Business Name): ROBERT L SEYMOUR DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 RANDOLPH RD STE 510
CHARLOTTE NC
28207-2027
US

IV. Provider business mailing address

2711 RANDOLPH RD STE 510
CHARLOTTE NC
28207-2027
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-9065
  • Fax: 704-377-1437
Mailing address:
  • Phone: 704-377-9065
  • Fax: 704-377-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4112
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT LEE SEYMOUR
Title or Position: DOCTOR
Credential: DDS
Phone: 704-377-9065