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General NPI Number Information
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NPI Number | 1114150760
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Entity Type | Individual
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Provider Name | KELLY ADAIR SEEBALDT D.M.D
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Gender | Male
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 1 11TH AVE SUITE D-3
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City | SHALIMAR
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State | FL
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Zip | 32579-1324
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Country | US
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Telephone | 850-651-6700
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Fax | 850-609-0796
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Provider Business Mailing Address
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Address Line | 1 ELEVENTH AVE. SUITE D-3
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City | SHALIMAR
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State | FL
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Zip | 32579
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Country | US
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Telephone | 850-651-6700
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Fax | 850-609-0796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 18698
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License Number State | FL
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