MEDICARE: DR. MARI B SEEGER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D7628	OR

General Provider Information

NPI Number	:	1083614853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARI B SEEGER DMD

Provider Business Mailing Address
First Line	:	4074 NW SALTZMAN RD
Second Line	:	SUITE 107
City	:	PORTLAND
State	:	OR
Zip	:	97229-2423
Country	:	US
Telephone Number	:	503-614-9766
Fax Number	:

Provider Business Practice Location Address
First Line	:	4074 NW SALTZMAN RD
Second Line	:	SUITE 107
City	:	PORTLAND
State	:	OR
Zip	:	97229-2423
Country	:	US
Telephone Number	:	503-629-8005
Fax Number	:	503-629-9775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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