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General NPI Number Information
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NPI Number | 1619351400
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Entity Type | Organization
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Legal Business Name | SEALE FAMILY DENTAL PC
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Dates
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Enumeration Date | 07/12/2015
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Last Update Date | 07/12/2015
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Provider Practice Location Address
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Address Line | 1209 6TH ST
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City | LEEDS
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State | AL
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Zip | 35094-2146
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Country | US
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Telephone | 205-699-2731
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Fax |
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Provider Business Mailing Address
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Address Line | 205 HIGHLAND AVE
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City | TRUSSVILLE
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State | AL
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Zip | 35173-1228
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Country | US
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Telephone | 256-566-1980
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW JONATHAN SEALE
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Credential |
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Telephone | 256-566-1980
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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 | 6025
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License Number State | AL
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