Provider Demographics
NPI:1750667564
Name:JOHN F SEIDEL DDS PA
Entity type:Organization
Organization Name:JOHN F SEIDEL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-749-6822
Mailing Address - Street 1:1346 S DIVISION ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7021
Mailing Address - Country:US
Mailing Address - Phone:410-749-6822
Mailing Address - Fax:
Practice Address - Street 1:1346 S DIVISION ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7021
Practice Address - Country:US
Practice Address - Phone:410-749-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11378261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD369QMedicare PIN
MDU58461Medicare UPIN