Healthcare Provider Details

I. General information

NPI: 1740379205
Provider Name (Legal Business Name): PERRY STUART SEIDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 N UNIVERSITY DR SUITE 104
PEMBROKE PINES FL
33024
US

IV. Provider business mailing address

3157 N UNIVERSITY DR SUITE 104
PEMBROKE PINES FL
33024
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-1600
  • Fax: 954-432-7994
Mailing address:
  • Phone: 954-431-1600
  • Fax: 954-432-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN7416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: