Provider Demographics
NPI:1003049875
Name:SEYER ORAL PATHOLOGY, LLC
Entity Type:Organization
Organization Name:SEYER ORAL PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-830-4897
Mailing Address - Street 1:3774 AFSHARI'S CIR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1535
Mailing Address - Country:US
Mailing Address - Phone:314-830-4897
Mailing Address - Fax:314-830-4877
Practice Address - Street 1:3439 BRIDGELAND DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2604
Practice Address - Country:US
Practice Address - Phone:314-291-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000301291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770562068OtherINDIVIDUAL NPI