Healthcare Provider Details

I. General information

NPI: 1356358576
Provider Name (Legal Business Name): ROBERT LEE SEYMOUR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S CENTRAL AVE
LOCUST NC
28097-7142
US

IV. Provider business mailing address

4007 WINTERBERRY PL
CHARLOTTE NC
28210-7329
US

V. Phone/Fax

Practice location:
  • Phone: 704-888-6247
  • Fax:
Mailing address:
  • Phone: 704-607-4267
  • Fax:

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:
Title or Position:
Credential:
Phone: