Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DS026049L | PA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS026049L | PA |
NPI | 1568432870 |
---|---|
Provider Name | Dr. Gary Warner Seldomridge |
First Address | Lancaster, PA 17603 |
Second Address | Lancaster, PA 17603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730915 | (05) | PA |
32271 | BLUE SHIELD (01) | PA |
DS026049L | DENTAL LICENSE (01) | PA |
T30033 | (02) | PA |