Provider Demographics
NPI:1710184064
Name:DANNIS, SETH MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:MICHAEL
Last Name:DANNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:96 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2511
Mailing Address - Country:US
Mailing Address - Phone:973-744-3166
Mailing Address - Fax:973-744-3199
Practice Address - Street 1:96 GATES AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2511
Practice Address - Country:US
Practice Address - Phone:973-744-3166
Practice Address - Fax:973-744-3199
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08598000207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery