Healthcare Provider Details

I. General information

NPI: 1528163631
Provider Name (Legal Business Name): BRITTANY SEYMOUR DDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE REB 204
BOSTON MA
02115-5819
US

IV. Provider business mailing address

188 LONGWOOD AVE REB 204
BOSTON MA
02115-5819
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1848
  • Fax: 617-432-0047
Mailing address:
  • Phone: 617-432-1848
  • Fax: 617-432-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8980
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: