Provider Demographics
NPI:1134299258
Name:LAWRENCE R SIEGEL DDS PA
Entity Type:Organization
Organization Name:LAWRENCE R SIEGEL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-295-0208
Mailing Address - Street 1:1802 YARDLEY RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-295-0208
Mailing Address - Fax:215-295-0867
Practice Address - Street 1:1802 YARDLEY RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-295-0208
Practice Address - Fax:215-295-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016541L1223X0400X
NJ22D1008475001223X0400X
NY03101911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty