Healthcare Provider Details

I. General information

NPI: 1841289238
Provider Name (Legal Business Name): DENNIS M SEUBERT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34803 JACKSON II RD
CARTHAGE NY
13619-8558
US

IV. Provider business mailing address

9 BRIDGE ST
CARTHAGE NY
13619-1333
US

V. Phone/Fax

Practice location:
  • Phone: 315-493-7768
  • Fax:
Mailing address:
  • Phone: 315-493-3210
  • Fax: 315-493-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number033903-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: