Healthcare Provider Details

I. General information

NPI: 1639597073
Provider Name (Legal Business Name): JMS BELTLINE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 N BELT LINE RD STE 110
IRVING TX
75062-6804
US

IV. Provider business mailing address

PO BOX 543248
GRAND PRAIRIE TX
75054-3248
US

V. Phone/Fax

Practice location:
  • Phone: 214-995-5149
  • Fax: 214-367-5896
Mailing address:
  • Phone: 214-995-5149
  • Fax: 214-367-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19808
License Number StateTX

VIII. Authorized Official

Name: DR. JEFFERY M SEIBERT
Title or Position: OWNER/ DENTIST
Credential: D.D.S.
Phone: 903-288-9066