Healthcare Provider Details

I. General information

NPI: 1669676573
Provider Name (Legal Business Name): SEABORN MICHAEL THURMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 TWO ISLAND CT UNIT 101
MOUNT PLEASANT SC
29466-7405
US

IV. Provider business mailing address

1203 TWO ISLAND CT UNIT 101
MOUNT PLEASANT SC
29466-7405
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-6166
  • Fax: 843-884-1140
Mailing address:
  • Phone: 843-884-6166
  • Fax: 843-884-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1834
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: