Provider Demographics
NPI:1548248958
Name:SEDBERRY, DONALD CHESLEY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHESLEY
Last Name:SEDBERRY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8536 ALYDAR CIR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4434
Mailing Address - Country:US
Mailing Address - Phone:210-292-6285
Mailing Address - Fax:210-292-2740
Practice Address - Street 1:1615 TRUEMPER ST
Practice Address - Street 2:
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-5511
Practice Address - Country:US
Practice Address - Phone:210-292-6285
Practice Address - Fax:210-292-2740
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS 023700L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice