Provider Demographics
NPI:1780692756
Name:SEELEY, ALLEN MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MARK
Last Name:SEELEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:M
Other - Last Name:SEELEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDC
Mailing Address - Street 1:1 HALLOCK MEADOW DR. SO.
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2936
Mailing Address - Country:US
Mailing Address - Phone:631-246-5401
Mailing Address - Fax:631-246-8803
Practice Address - Street 1:1 HALLOCK MEADOW DR. SO.
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2936
Practice Address - Country:US
Practice Address - Phone:631-246-5401
Practice Address - Fax:631-246-8803
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0342881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics