Provider Demographics
NPI:1821738873
Name:SEASE, SIDNEY (DDS)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:SEASE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10266 TWO NOTCH RD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4400
Mailing Address - Country:US
Mailing Address - Phone:803-865-9334
Mailing Address - Fax:
Practice Address - Street 1:10266 TWO NOTCH RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-4400
Practice Address - Country:US
Practice Address - Phone:803-865-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.102451223G0001X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program