Provider Demographics
NPI:1548246077
Name:SAISSELIN, BRADLEY DREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DREW
Last Name:SAISSELIN
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 1:4 LYNIAN WAY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-343-5310
Mailing Address - Fax:
Practice Address - Street 1:12 NEW STREET
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-342-5800
Practice Address - Fax:315-342-2014
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00652933Medicaid
NY00652933Medicaid
XAS980428HOtherDEA