Provider Demographics
NPI:1699153304
Name:SEYFRIED & ASSOCIATES PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SEYFRIED & ASSOCIATES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-645-0780
Mailing Address - Street 1:40646 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5014
Mailing Address - Country:US
Mailing Address - Phone:248-658-0780
Mailing Address - Fax:
Practice Address - Street 1:40646 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5014
Practice Address - Country:US
Practice Address - Phone:248-658-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty