1255654232 NPI number — MR. THOMAS B SEIFERT DDS

Table of content: MR. THOMAS B SEIFERT DDS (NPI 1255654232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255654232 NPI number — MR. THOMAS B SEIFERT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIFERT
Provider First Name:
THOMAS
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255654232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 5TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33881-4672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-291-5110
Provider Business Mailing Address Fax Number:
863-291-5128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 K D REVELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUCHULA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33873-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-767-0696
Provider Business Practice Location Address Fax Number:
863-767-0697
Provider Enumeration Date:
03/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN6990 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001941900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".