Provider Demographics
NPI:1093853988
Name:SEELAM, SRUJANA (DDS)
Entity Type:Individual
Prefix:
First Name:SRUJANA
Middle Name:
Last Name:SEELAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 NEW HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2137
Mailing Address - Country:US
Mailing Address - Phone:717-293-8696
Mailing Address - Fax:717-464-1198
Practice Address - Street 1:792 NEW HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2137
Practice Address - Country:US
Practice Address - Phone:717-293-8696
Practice Address - Fax:717-293-8693
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist