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General NPI Number Information
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NPI Number | 1790007086
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Entity Type | Organization
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Legal Business Name | JONG-BUM SEO AND YVONNE LEE, D.M.D., P.A.
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Dates
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Enumeration Date | 02/27/2010
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Last Update Date | 02/27/2010
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Provider Practice Location Address
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Address Line | 9944 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1804
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Country | US
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Telephone | 410-922-5500
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Fax | 410-922-5537
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Provider Business Mailing Address
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Address Line | 9944 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1804
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Country | US
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Telephone | 410-922-5500
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Fax | 410-922-5537
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONG-BUM SEO
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Credential | D.M.D.
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Telephone | 410-922-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14142
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License Number State | MD
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