Basic Information
Provider Information
NPI: 1871070177
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SETO
FirstName: HIDEKI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 130 VAN CORTLANDT AVE W APT 2F
Address2:  
City: BRONX
State: NY
PostalCode: 104632747
CountryCode: US
TelephoneNumber: 6463394311
FaxNumber:  
Practice Location
Address1: 163 FORT EVANS RD NE
Address2:  
City: LEESBURG
State: VA
PostalCode: 201764420
CountryCode: US
TelephoneNumber: 7034432000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/19/2018
LastUpdateDate: 11/25/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X0401416090VAY Dental ProvidersDentist 

No ID Information.


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