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General NPI Number Information
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NPI Number | 1265425987
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Entity Type | Individual
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Provider Name | STEVEN W. SEIBERT D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 3002 CROSSING CT
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6135
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Country | US
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Telephone | 217-398-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 1804 BENTBROOK DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-9218
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Country | US
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Telephone | 217-352-2711
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021001261
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License Number State | IL
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