Provider Demographics
NPI:1093891848
Name:GLENN C SEITZ PC
Entity Type:Organization
Organization Name:GLENN C SEITZ PC
Other - Org Name:LOCUST LANE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-652-6352
Mailing Address - Street 1:5525 LOCUST LANE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109
Mailing Address - Country:US
Mailing Address - Phone:717-652-6352
Mailing Address - Fax:717-541-0771
Practice Address - Street 1:5525 LOCUST LANE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-652-6352
Practice Address - Fax:717-541-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030972L122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty