MEDICARE: DR. BRYAN ALLEN SEYFERTH DDS

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	12010376A	IN

General Provider Information

NPI Number	:	1659515666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN ALLEN SEYFERTH DDS

Provider Business Mailing Address
First Line	:	2620 E 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2934
Country	:	US
Telephone Number	:	317-251-2371
Fax Number	:	317-333-6446

Provider Business Practice Location Address
First Line	:	2620 E 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2934
Country	:	US
Telephone Number	:	317-251-2371
Fax Number	:	317-333-6446

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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