Healthcare Provider Details

I. General information

NPI: 1083614853
Provider Name (Legal Business Name): MARI B SEEGER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4074 NW SALTZMAN RD SUITE 107
PORTLAND OR
97229-2423
US

IV. Provider business mailing address

4074 NW SALTZMAN RD SUITE 107
PORTLAND OR
97229-2423
US

V. Phone/Fax

Practice location:
  • Phone: 503-629-8005
  • Fax: 503-629-9775
Mailing address:
  • Phone: 503-614-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7628
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: