MEDICARE: DR. BRUCE G SEADER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33404	NY

General Provider Information

NPI Number	:	1487609152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE G SEADER DDS

Provider Business Mailing Address
First Line	:	1 ELM ST
Second Line	:	SUITE 1-A
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3925
Country	:	US
Telephone Number	:	914-793-9080
Fax Number	:	914-337-7141

Provider Business Practice Location Address
First Line	:	1 ELM ST
Second Line	:	SUITE 1-A
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3925
Country	:	US
Telephone Number	:	914-793-9080
Fax Number	:	914-337-7141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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