Provider Demographics
NPI:1679144489
Name:SEELY, LAURA (DMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SEELY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 SNELLING AVE N # 250
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1700
Mailing Address - Country:US
Mailing Address - Phone:651-688-1834
Mailing Address - Fax:
Practice Address - Street 1:2690 SNELLING AVE N # 250
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1700
Practice Address - Country:US
Practice Address - Phone:651-633-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist