Provider Demographics
NPI:1104340025
Name:SEELY, JOHN TIMOTHY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TIMOTHY
Last Name:SEELY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CASABLANCA DR BLDG 1445
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31409-5107
Mailing Address - Country:US
Mailing Address - Phone:571-801-7148
Mailing Address - Fax:
Practice Address - Street 1:230 CASABLANCA DR BLDG 1445
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5107
Practice Address - Country:US
Practice Address - Phone:571-801-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012730A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty