Provider Demographics
NPI:1396001483
Name:SEUBERT, CHAD RANDALL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RANDALL
Last Name:SEUBERT
Suffix:
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 1:3164 FINGER RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7602
Mailing Address - Country:US
Mailing Address - Phone:920-471-0022
Mailing Address - Fax:920-471-0755
Practice Address - Street 1:3164 FINGER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7602
Practice Address - Country:US
Practice Address - Phone:920-471-0022
Practice Address - Fax:920-471-0755
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3621223S0112X
WI10012611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery