Provider Demographics
NPI:1114545969
Name:SIEH, DASIRAE DANIELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DASIRAE
Middle Name:DANIELLE
Last Name:SIEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-3047
Mailing Address - Country:US
Mailing Address - Phone:901-448-5500
Mailing Address - Fax:
Practice Address - Street 1:875 UNION AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-9375
Practice Address - Country:US
Practice Address - Phone:901-448-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7625OtherSTATE OF NEBRASKA - DHHS