Provider Demographics
NPI:1780045880
Name:SETH REDER, DDS, INC.
Entity type:Organization
Organization Name:SETH REDER, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-464-5555
Mailing Address - Street 1:2001 40TH AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2536
Mailing Address - Country:US
Mailing Address - Phone:831-464-5555
Mailing Address - Fax:831-464-5558
Practice Address - Street 1:2001 40TH AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2536
Practice Address - Country:US
Practice Address - Phone:831-464-5555
Practice Address - Fax:831-464-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56012261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental