Provider Demographics
NPI:1366558637
Name:SEILER, CONNY L (DDS)
Entity type:Individual
Prefix:DR
First Name:CONNY
Middle Name:L
Last Name:SEILER
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 1:3010 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-1771
Mailing Address - Country:US
Mailing Address - Phone:303-463-2642
Mailing Address - Fax:
Practice Address - Street 1:100 ACOMA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1464
Practice Address - Country:US
Practice Address - Phone:303-778-6703
Practice Address - Fax:303-463-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1054331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02054336Medicaid