MEDICARE: DR. JASON H SEO D.D.S., M.S.

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	1223P0700X	Prosthodontics	DI019860	NJ

General Provider Information

NPI Number	:	1619096310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON H SEO D.D.S., M.S.

Provider Business Mailing Address
First Line	:	330 RATZER RD
Second Line	:	SUITE C-22
City	:	WAYNE
State	:	NJ
Zip	:	07470-7702
Country	:	US
Telephone Number	:	973-696-5258
Fax Number	:	973-696-5290

Provider Business Practice Location Address
First Line	:	330 RATZER RD
Second Line	:	SUITE C-22
City	:	WAYNE
State	:	NJ
Zip	:	07470-7702
Country	:	US
Telephone Number	:	973-696-5258
Fax Number	:	973-696-5290

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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