Provider Demographics
NPI:1043230543
Name:SIEGEL, JEFFREY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 206N
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3422
Mailing Address - Country:US
Mailing Address - Phone:561-395-8080
Mailing Address - Fax:561-395-0813
Practice Address - Street 1:7280 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 206N
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3422
Practice Address - Country:US
Practice Address - Phone:561-395-8080
Practice Address - Fax:561-395-0813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00101621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice