Healthcare Provider Details

I. General information

NPI: 1881891349
Provider Name (Legal Business Name): JOHN JOSHUA SEALE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 RR 255 WEST
BROOKELAND TX
75931
US

IV. Provider business mailing address

PO BOX 5210
SAM RAYBURN TX
75951
US

V. Phone/Fax

Practice location:
  • Phone: 409-698-8800
  • Fax: 409-698-8801
Mailing address:
  • Phone: 409-698-8800
  • Fax: 409-698-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: