Provider Demographics
NPI:1902936388
Name:SEYMOUR, ROBERT BURDETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BURDETTE
Last Name:SEYMOUR
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 1:460 BYHALIA RD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1319
Mailing Address - Country:US
Mailing Address - Phone:662-429-5239
Mailing Address - Fax:662-449-0758
Practice Address - Street 1:460 BYHALIA RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1319
Practice Address - Country:US
Practice Address - Phone:662-429-5239
Practice Address - Fax:662-449-0758
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1472-711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS72340OtherBLUE CROSS BLUE SHIELD
MS113895OtherUNITED CONCORDIA