MEDICARE: DR. MISTY MAE SEALE D.M.D.

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	122300000X	Dentist	DN014852	GA

General Provider Information

NPI Number	:	1780086595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MISTY MAE SEALE D.M.D.

Provider Business Mailing Address
First Line	:	135 GOSHEN ROAD
Second Line	:	SUITE 205
City	:	RINCON
State	:	GA
Zip	:	31326-5546
Country	:	US
Telephone Number	:	912-499-1133
Fax Number	:	912-348-5806

Provider Business Practice Location Address
First Line	:	135 GOSHEN ROAD
Second Line	:	SUITE 205
City	:	RINCON
State	:	GA
Zip	:	31326-5546
Country	:	US
Telephone Number	:	912-499-1133
Fax Number	:	912-348-5806

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	02/04/2026

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