Provider Demographics
NPI:1023105004
Name:SEIDEL, SHELDON RONALD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:RONALD
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:STE. 201B
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3031
Mailing Address - Country:US
Mailing Address - Phone:410-257-0353
Mailing Address - Fax:
Practice Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:STE. 201B
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3031
Practice Address - Country:US
Practice Address - Phone:410-257-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics