1104340025 NPI number — DR. JOHN TIMOTHY SEELY JR. DDS

Table of content: DR. JOHN TIMOTHY SEELY JR. DDS (NPI 1104340025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104340025 NPI number — DR. JOHN TIMOTHY SEELY JR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEELY
Provider First Name:
JOHN
Provider Middle Name:
TIMOTHY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
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:
1104340025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
334 HEARD AVE
Provider Second Line Business Mailing Address:
BLDG 556
Provider Business Mailing Address City Name:
SCHOFIELD BARRACKS
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-655-8800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
577 STERNBERG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT EUSTIS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23604-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-314-7944
Provider Business Practice Location Address Fax Number:
757-314-7942
Provider Enumeration Date:
08/02/2017

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:  12012730A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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