Healthcare Provider Details

I. General information

NPI: 1952093056
Provider Name (Legal Business Name): JACOB ROBERT SEANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 S WESTERN AVE STE 1
OKLAHOMA CITY OK
73139-2411
US

IV. Provider business mailing address

7801 S WESTERN AVE STE 1
OKLAHOMA CITY OK
73139-2411
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-3399
  • Fax: 405-256-1191
Mailing address:
  • Phone: 405-691-3399
  • Fax: 405-256-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8246
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: