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General NPI Number Information
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NPI Number | 1851820757
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Entity Type | Individual
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Provider Name | TANNER A. SEAGO DMD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 06/06/2017
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Provider Practice Location Address
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Address Line | 405 2ND ST
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City | MARIETTA
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State | OH
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Zip | 45750-2150
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Country | US
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Telephone | 740-373-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TIBER WAY
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City | MARIETTA
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State | OH
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Zip | 45750-2911
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Country | US
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Telephone | 614-315-0160
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30025139
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License Number State | OH
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