Healthcare Provider Details

I. General information

NPI: 1891797916
Provider Name (Legal Business Name): IRWIN M SEIDMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N NORTH CT STE 250
PALATINE IL
60067-8128
US

IV. Provider business mailing address

600 N NORTH CT STE 250
PALATINE IL
60067-8128
US

V. Phone/Fax

Practice location:
  • Phone: 847-991-4663
  • Fax: 847-991-4693
Mailing address:
  • Phone: 847-991-4663
  • Fax: 847-991-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: