Provider Demographics
NPI:1114024205
Name:SIEGERT, ROBERT ELMER (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELMER
Last Name:SIEGERT
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 1:15875 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3884
Mailing Address - Country:US
Mailing Address - Phone:734-427-7337
Mailing Address - Fax:734-427-9874
Practice Address - Street 1:15875 MIDDLEBELT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3884
Practice Address - Country:US
Practice Address - Phone:734-427-7337
Practice Address - Fax:734-427-9874
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI90161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice