MEDICARE: DR. AMY LYNN SEAGRAVES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019032522	IL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30027680	OH

General Provider Information

NPI Number	:	1497382113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LYNN SEAGRAVES DDS

Provider Business Mailing Address
First Line	:	1221 W 65TH ST UNIT 6615
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2197
Country	:	US
Telephone Number	:	330-360-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	15380 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4824
Country	:	US
Telephone Number	:	440-530-9336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	11/14/2024

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