1164623732 NPI number — GEORGE N SELIGMAN DDS

Table of content: GEORGE N SELIGMAN DDS (NPI 1164623732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164623732 NPI number — GEORGE N SELIGMAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELIGMAN
Provider First Name:
GEORGE
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1164623732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33200 W 14 MILE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
W BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-3563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-406-0180
Provider Business Mailing Address Fax Number:
248-406-5088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33200 W 14 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
W BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-406-0180
Provider Business Practice Location Address Fax Number:
248-406-5088
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2901011122 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2901011122 . This is a "STATE OF MICHIGAN DENTAL LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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