Provider Demographics
NPI:1063684603
Name:CHARLES M SEITZ DDS PC
Entity Type:Organization
Organization Name:CHARLES M SEITZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-489-1808
Mailing Address - Street 1:1047 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1022
Mailing Address - Country:US
Mailing Address - Phone:617-489-1808
Mailing Address - Fax:617-489-4527
Practice Address - Street 1:1047 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1022
Practice Address - Country:US
Practice Address - Phone:617-489-1808
Practice Address - Fax:617-489-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0251259Medicaid