1689767428 NPI number — MICHAEL P. SEIDMAN

Table of content: (NPI 1689767428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689767428 NPI number — MICHAEL P. SEIDMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL P. SEIDMAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DENTAL ASSOCIATES OF CAPE COD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689767428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
262 BARNSTABLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-778-1200
Provider Business Mailing Address Fax Number:
508-775-5502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 BARNSTABLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-778-1200
Provider Business Practice Location Address Fax Number:
508-775-5502
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEIDMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
508-778-1200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  16315 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25259 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 380021 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: X10615 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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