Organization
CONSHOHOCKEN DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WANSUK SETH SEO DMD (PRESIDENT)
(610) 828-3535
Entity
Organization
Contact information
Practice address
200 W RIDGE PIKE, SUITE #129, CONSHOHOCKEN, PA 19428-3702
(610) 828-3535
(610) 828-3558
Mailing address
200 W RIDGE PIKE, SUITE #129, CONSHOHOCKEN, PA 19428-3702
(610) 828-3535
(610) 828-3558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS038105
PA
1223G0001X
General Practice Dentistry
Primary
DS036612
PA
1223P0300X
Periodontics
DS035484
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102564482
—
PA
Enumeration date
05/17/2011
Last updated
05/17/2011
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