Healthcare Provider Details

I. General information

NPI: 1588677595
Provider Name (Legal Business Name): SEYED M. SHAMSEDDIN, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 LINCOLN DR W STE H
MARLTON NJ
08053-3204
US

IV. Provider business mailing address

9002 LINCOLN DR W SUITE H
MARLTON NJ
08053-3204
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-3450
  • Fax: 856-983-9877
Mailing address:
  • Phone: 856-983-3450
  • Fax: 856-983-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02035800
License Number StateNJ

VIII. Authorized Official

Name: DR. SEYED SHAMSEDDIN
Title or Position: OWNER
Credential: DDS
Phone: 856-983-3450