Provider Demographics
NPI:1427170786
Name:SEIFODDINI, FREDA (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDA
Middle Name:
Last Name:SEIFODDINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E 74TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3218
Mailing Address - Country:US
Mailing Address - Phone:212-737-1787
Mailing Address - Fax:
Practice Address - Street 1:175 E 74TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3218
Practice Address - Country:US
Practice Address - Phone:212-737-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0479251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice