Provider Demographics
NPI:1841356649
Name:SEIDBERG, BRUCE HARVEY (DDS, MSCD, JD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HARVEY
Last Name:SEIDBERG
Suffix:
Gender:M
Credentials:DDS, MSCD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 W TAFT RD
Mailing Address - Street 2:SUITE 'R'
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4868
Mailing Address - Country:US
Mailing Address - Phone:315-453-3636
Mailing Address - Fax:315-466-3636
Practice Address - Street 1:5112 W TAFT ROAD
Practice Address - Street 2:SUITE 'R'
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4868
Practice Address - Country:US
Practice Address - Phone:315-453-3636
Practice Address - Fax:315-466-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0241911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics