Provider Demographics
NPI:1497382113
Name:SEAGRAVES, AMY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W 65TH ST UNIT 6615
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2197
Mailing Address - Country:US
Mailing Address - Phone:330-360-4241
Mailing Address - Fax:
Practice Address - Street 1:15380 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4824
Practice Address - Country:US
Practice Address - Phone:440-530-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190325221223X0400X
OH300276801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty