Provider Demographics
NPI:1043888472
Name:SIREGAR, MELODY (RDH)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SIREGAR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8079 WOLFF ST UNIT L
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-7007
Mailing Address - Country:US
Mailing Address - Phone:720-361-8769
Mailing Address - Fax:
Practice Address - Street 1:8079 WOLFF ST UNIT L
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7007
Practice Address - Country:US
Practice Address - Phone:720-361-8769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002026081124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist