Provider Demographics
NPI:1568506608
Name:SEBERT, DAVID ALLAN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLAN
Last Name:SEBERT
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 1:214 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1318
Mailing Address - Country:US
Mailing Address - Phone:304-645-2587
Mailing Address - Fax:304-645-2587
Practice Address - Street 1:214 SENECA TRL
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1318
Practice Address - Country:US
Practice Address - Phone:304-645-2587
Practice Address - Fax:304-645-2587
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135941000Medicaid