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General NPI Number Information
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NPI Number | 1518964402
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Entity Type | Organization
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Legal Business Name | ROSELLE DENTAL CENTER PC
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 603 E IRVING PARK RD
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City | ROSELLE
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State | IL
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Zip | 60172-2302
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Country | US
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Telephone | 630-893-4200
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Fax | 630-893-4508
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Provider Business Mailing Address
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Address Line | 603 E IRVING PARK RD
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City | ROSELLE
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State | IL
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Zip | 60172-2302
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Country | US
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Telephone | 630-893-4200
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Fax | 630-893-4508
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. HARVEY G SEYBOLD
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Credential | DDS
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Telephone | 630-893-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019017668
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License Number State | IL
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