Provider Demographics
NPI:1699597740
Name:KILLACKEY-SEAVER, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KILLACKEY-SEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FALLS BLVD UNIT D309
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8190
Mailing Address - Country:US
Mailing Address - Phone:857-389-7706
Mailing Address - Fax:
Practice Address - Street 1:4 KEITH WAY STE 3
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4258
Practice Address - Country:US
Practice Address - Phone:781-608-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH89452124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist