Provider Demographics
NPI:1770562068
Name:SEYER, BRADLEY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALAN
Last Name:SEYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3439 BRIDGELAND DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2604
Mailing Address - Country:US
Mailing Address - Phone:314-830-4897
Mailing Address - Fax:314-830-4877
Practice Address - Street 1:3439 BRIDGELAND DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2604
Practice Address - Country:US
Practice Address - Phone:314-278-9375
Practice Address - Fax:314-499-8293
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020003011223P0106X
IL0190257871223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU97967Medicare UPIN
MO000025579Medicare ID - Type UnspecifiedPROVIDER NUMBER