Healthcare Provider Details

I. General information

NPI: 1538337803
Provider Name (Legal Business Name): CHARLES DAVID SEIDMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BALTIMORE BLVD
FINKSBURG MD
21048-1648
US

IV. Provider business mailing address

2222 BALTIMORE BLVD P.O. BOX 816
FINKSBURG MD
21048-1648
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-2774
  • Fax: 410-751-2907
Mailing address:
  • Phone: 410-876-2774
  • Fax: 410-751-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6724
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: