Provider Demographics
NPI:1821265125
Name:SEIDMAN, SHELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:SEIDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1014
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4104
Mailing Address - Country:US
Mailing Address - Phone:312-644-4321
Mailing Address - Fax:312-644-4325
Practice Address - Street 1:400 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1014
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4104
Practice Address - Country:US
Practice Address - Phone:312-644-4321
Practice Address - Fax:312-644-4325
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist