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General NPI Number Information
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NPI Number | 1457892341
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Entity Type | Organization
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Legal Business Name | SEITER FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 2157 PRINCE ST
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City | CONWAY
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State | AR
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Zip | 72034-3737
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Country | US
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Telephone | 501-470-6468
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Fax |
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Provider Business Mailing Address
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Address Line | 2445 LANDOVER TRL
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City | CONWAY
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State | AR
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Zip | 72032-2628
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Country | US
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Telephone | 501-470-6468
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST/ OWNER
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Name | DR. JACOB LAWRENCE SEITER
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Credential | D.D.S.
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Telephone | 501-470-6468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4036
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License Number State | AR
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