Healthcare Provider Details

I. General information

NPI: 1518223627
Provider Name (Legal Business Name): RYAN LEO SEEGMILLER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 VALLEY FORGE ST
COMANCHE TX
76442-1815
US

IV. Provider business mailing address

203 VALLEY FORGE ST
COMANCHE TX
76442-1815
US

V. Phone/Fax

Practice location:
  • Phone: 325-356-5263
  • Fax: 325-356-2875
Mailing address:
  • Phone: 325-356-5263
  • Fax: 325-356-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: