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General NPI Number Information
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NPI Number | 1932627114
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Entity Type | Organization
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Legal Business Name | SEALY ORTHODONTICS-SEALY PLLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2355 HWY 36 SOUTH
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City | SEALY
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State | TX
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Zip | 77474
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Country | US
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Telephone | 979-885-4856
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Fax | 979-885-6524
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Provider Business Mailing Address
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Address Line | 2355 HWY 36 SOUTH
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City | SEALY
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State | TX
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Zip | 77474
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Country | US
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Telephone | 979-885-4856
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Fax | 979-885-6524
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Authorized Official
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Title or Position | PRESIDENT
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Name | WESLEY ZBORIL
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Credential | DDS
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Telephone | 979-885-4856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30729
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License Number State | TX
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