Healthcare Provider Details

I. General information

NPI: 1972956571
Provider Name (Legal Business Name): CHAD R SEABOLD DDS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 POST OAK PLACE DR STE 160
HOUSTON TX
77027-3127
US

IV. Provider business mailing address

4550 POST OAK PLACE DR STE 160
HOUSTON TX
77027-3127
US

V. Phone/Fax

Practice location:
  • Phone: 713-981-0000
  • Fax:
Mailing address:
  • Phone: 713-981-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number28778
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number24183
License Number StateTX

VIII. Authorized Official

Name: CHAD R SEABOLD
Title or Position: OWNER
Credential: DDS MD
Phone: 713-981-0000