MEDICARE: IRWIN M SEIDMAN D.D.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	1223P0221X	Pediatric Dentistry		IL

General Provider Information

NPI Number	:	1891797916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRWIN M SEIDMAN D.D.S.

Provider Business Mailing Address
First Line	:	600 N NORTH CT
Second Line	:	STE 250
City	:	PALATINE
State	:	IL
Zip	:	60067-8128
Country	:	US
Telephone Number	:	847-991-4663
Fax Number	:	847-991-4693

Provider Business Practice Location Address
First Line	:	600 N NORTH CT
Second Line	:	STE 250
City	:	PALATINE
State	:	IL
Zip	:	60067-8128
Country	:	US
Telephone Number	:	847-991-4663
Fax Number	:	847-991-4693

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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