Healthcare Provider Details

I. General information

NPI: 1376779967
Provider Name (Legal Business Name): SETH RHOADES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 S SENECA AVE
NEWCASTLE WY
82701-2816
US

IV. Provider business mailing address

PO BOX 190
NEWCASTLE WY
82701-0190
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-4772
  • Fax: 307-746-2472
Mailing address:
  • Phone: 307-746-4772
  • Fax: 307-746-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6821
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1264
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: