Provider Demographics
NPI:1144316381
Name:BLITZER, SETH M (DMD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:M
Last Name:BLITZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 SPROUL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3511
Mailing Address - Country:US
Mailing Address - Phone:610-356-3010
Mailing Address - Fax:610-356-3339
Practice Address - Street 1:2004 SPROUL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-356-3010
Practice Address - Fax:610-356-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026360L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice