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General NPI Number Information
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NPI Number | 1174931133
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Entity Type | Individual
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Provider Name | JEONG HO SEO DMD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 7900 S J STOCK RD
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City | TUCSON
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State | AZ
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Zip | 85746-7012
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Country | US
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Telephone | 520-295-2575
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 S J STOCK RD
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City | TUCSON
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State | AZ
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Zip | 85746-7012
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Country | US
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Telephone |
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D009986
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE61155736
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License Number State | WA
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