Provider Demographics
NPI:1497750913
Name:WALLERSTEIN, SETH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:M
Last Name:WALLERSTEIN
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 1:25 S MAIN ST
Mailing Address - Street 2:STE 9
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3448
Mailing Address - Country:US
Mailing Address - Phone:732-494-0700
Mailing Address - Fax:732-494-5599
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:STE 9
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3448
Practice Address - Country:US
Practice Address - Phone:732-494-0700
Practice Address - Fax:732-494-5599
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015929001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice