Provider Demographics
NPI:1073850830
Name:SEAFORD DENTAL PC
Entity Type:Organization
Organization Name:SEAFORD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:AFFRUNTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-781-4990
Mailing Address - Street 1:2125 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2605
Mailing Address - Country:US
Mailing Address - Phone:516-781-4990
Mailing Address - Fax:516-804-8506
Practice Address - Street 1:2125 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2605
Practice Address - Country:US
Practice Address - Phone:516-781-4990
Practice Address - Fax:516-804-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty