Provider Demographics
NPI:1639275878
Name:SEIDENSCHMID, MARTIN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
Last Name:SEIDENSCHMID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SE 120TH AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4094
Mailing Address - Country:US
Mailing Address - Phone:360-260-3290
Mailing Address - Fax:360-260-3291
Practice Address - Street 1:300 SE 120TH AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4090
Practice Address - Country:US
Practice Address - Phone:360-260-3290
Practice Address - Fax:360-260-3291
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA89801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB27285Medicare PIN
WAU92899Medicare UPIN