Provider Demographics
NPI:1235114802
Name:SEIDEL, JOHN FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 S DIVISION ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7021
Mailing Address - Country:US
Mailing Address - Phone:410-749-6822
Mailing Address - Fax:
Practice Address - Street 1:1346 S DIVISION ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7021
Practice Address - Country:US
Practice Address - Phone:410-749-6822
Practice Address - Fax:410-749-7009
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
369QMedicare ID - Type Unspecified
MDU58461Medicare UPIN