Provider Demographics
NPI:1437208980
Name:SEID, WAYNE MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MATTHEW
Last Name:SEID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3706
Mailing Address - Country:US
Mailing Address - Phone:516-822-7053
Mailing Address - Fax:
Practice Address - Street 1:12419 101ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1409
Practice Address - Country:US
Practice Address - Phone:718-847-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046241-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740990Medicaid