Healthcare Provider Details

I. General information

NPI: 1558770958
Provider Name (Legal Business Name): RYAN L SEEGMILLER, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
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:
Mailing address:
  • Phone: 325-356-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number29007
License Number StateTX

VIII. Authorized Official

Name: DR. RYAN SEEGMILLER
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 801-458-7316