=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538220389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR RON J SEELEY D D S PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2224 1ST AVENUE WEST
-----------------------------------------------------
City | WILLISTON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-774-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2224 1ST AVENUE WEST
-----------------------------------------------------
City | WILLISTON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-774-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRES
-----------------------------------------------------
Name | DR. RONALD JAY SEELEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 701-774-0404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 1641
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------