Provider Demographics
NPI:1588677595
Name:SEYED M. SHAMSEDDIN, DDS, LLC
Entity Type:Organization
Organization Name:SEYED M. SHAMSEDDIN, DDS, LLC
Other - Org Name:GREENTREE PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSEDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-983-3450
Mailing Address - Street 1:9002 LINCOLN DR W
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3204
Mailing Address - Country:US
Mailing Address - Phone:856-983-3450
Mailing Address - Fax:856-983-9877
Practice Address - Street 1:9002 LINCOLN DR W STE H
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3204
Practice Address - Country:US
Practice Address - Phone:856-983-3450
Practice Address - Fax:856-983-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020358001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty