Basic Information
| Provider Information | |||||||||
| NPI: | 1003017005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIFERT | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | MARTINSEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463503506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193621101 | ||||||||
| FaxNumber: | 2193253550 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463503506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193621101 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 12010973A | IN | Y | Dental Providers | Dentist | General Practice |
No ID Information.