Provider Demographics
NPI:1578056172
Name:SEAGER, BEAU EDWARD (DMD)
Entity type:Individual
Prefix:
First Name:BEAU
Middle Name:EDWARD
Last Name:SEAGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11055 N ALPINE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8924
Mailing Address - Country:US
Mailing Address - Phone:801-756-2273
Mailing Address - Fax:
Practice Address - Street 1:9 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2097
Practice Address - Country:US
Practice Address - Phone:801-763-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12149027-99221223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice