Provider Demographics
NPI:1972887800
Name:STEPHEN B SEIDLER DDS PA
Entity Type:Organization
Organization Name:STEPHEN B SEIDLER DDS PA
Other - Org Name:SANFORD DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-320-1700
Mailing Address - Street 1:4942 W STATE ROAD 46
Mailing Address - Street 2:STE 1038
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9245
Mailing Address - Country:US
Mailing Address - Phone:407-320-1700
Mailing Address - Fax:
Practice Address - Street 1:4942 W STATE ROAD 46
Practice Address - Street 2:STE 1038
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9245
Practice Address - Country:US
Practice Address - Phone:407-320-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN86131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6616670001Medicare NSC