Provider Demographics
NPI:1124024179
Name:SIEGEL, ALAN GLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:GLEN
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 1:11111 N SCOTTSDALE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6731
Mailing Address - Country:US
Mailing Address - Phone:480-998-3923
Mailing Address - Fax:480-922-0864
Practice Address - Street 1:11111 N SCOTTSDALE RD STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6731
Practice Address - Country:US
Practice Address - Phone:480-998-3923
Practice Address - Fax:480-922-0864
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2019-09-09
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
AZ38161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice